Stroke as a manifestation of Lyme disease

Strokes should be added to the list of manifestations of Lyme disease based on a 2007 systematic review published in Frontiers in Neurology. [1] The authors identified 88 patients in the literature presenting with cerebrovascular course of Lyme neuroborreliosis (LNB).

 

by Daniel J. Cameron, MD MPH

More than half of the cases were from three countries: 16 (25.4%) from Germany, 9 (14.3%) from Switzerland, and 8 (12.7%) from France. Five cases (8%) were from the United States, notes Garkowski from the Medical University of Białystok in Poland. [1]

Many of the cases involved relatively young patients, with more than 50% under the age of 50. The authors identified 15 pediatric cases, noting the youngest to be 4 years of age. Patients ranged between 4 and 77 years old with a median age of 46. Males represented 54% of all the cases.

The most common cerebrovascular manifestation of LNB was ischemic stroke (76.1%), followed by [transient ischemic attack] (11.4%), according to Garkowski. [1] “The posterior circulation was affected alone in 37.8% of patients, the anterior circulation in 24.4% of patients, and in 37.8% of cases, posterior and anterior circulations were affected simultaneously.”

A complete response to antibiotic treatment occurred in 75% of the patients. The authors defined a complete response as, “halted progression of the disease and no recurrence of cerebral ischemia or recuperation from neurological deficits.” The mortality rate was 4.7%. The outcome for the remaining 20% was incomplete or incomplete with residual neurologic deficit.

The authors suggest prompt evaluation of prodromal syndromes. “The lack of awareness of this manifestation of LNB might result in the delay of diagnosis, which might lead even to the patient’s death,” warns Garkowski. [1] “Several weeks/months before stroke onset, prodromal symptoms suggesting LNB [Lyme neuroborreliosis], such as meningitis, cranial neuritis or radiculoneuritis, should prompt extensive diagnostics including CSF [cerebrospinal fluid] examination.”

Takeaway: Physicians should consider cerebral vasculitis and stroke due to Lyme neuroborreliosis in patients living in or having visited areas endemic for tick-borne diseases, and in those individuals who don’t have any cardiovascular risk factors but who exhibit stroke-like symptoms with no known cause.

More on the topic:
At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment 
What happens to the brain during acute Lyme neuroborreliosis?

 

References:

  1. Garkowski A, Zajkowska J, Zajkowska A, et al. Cerebrovascular Manifestations of Lyme Neuroborreliosis-A Systematic Review of Published Cases. Front Neurol. 2017;8:146.


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Dr. Daniel CameronTeresa Alaniz 8303102661Helen JarvisKarrie HilsingerCarolyn Mee Recent comment authors
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Teresa Alaniz 8303102661
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Teresa Alaniz 8303102661

I live in West Tx.I was diagnosed with chronic Lyme in 2008 believe to then have a 2nd infection, 1sts one in 1997. The 1st see of August 2018I had 5 new tick bites from the East in TN,NC,SC. Whithin 2 to 4 weeks I started having n nueroligical symptoms that increased daily. I have had 3 strokes in a week and a half. Im only 53 single mom off a13 yr old. Lyme is not recognized here, no one will listen or is helping me. I desperately need a doc too treat me. I’m begging for your help,, please!!!

Helen Jarvis
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Helen Jarvis

I was diagnosed in 2013 with Lyme disease but I believe based on my symptoms that mostly have gone away after 4 years of IV antibiotics that I got lyme disease as long ago as 1995 or before. I had an MRI done in 2016 which showed an old stroke surrounded by a large area of gliosis. My blood vessels were clean at the time of the MRI without any athlerosclerosis. Is it possible that the stroke occurred slowly over time? Or did it have to have occurred suddenly? I had no obvious symptoms such as weakness on the opposite… Read more »

Karrie Hilsinger
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Karrie Hilsinger

I’m very interested in understanding more. Feb 2017 I had at stroke at 42 years old and the 0nly thing I have going on with my health was a newer (~6 month) infection with Lyme. All my doctors are not in alignment with my neurologist who said Lyme caused my stroke. I’m at odds wondering if that is the true cause of the stroke.

Carolyn Mee
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Carolyn Mee

I have had Lyme disease with Ehrlichia since 2012. An MRI said I had a stoke and a spinal tap revealed rare white blood cells. I am still sick after being put on a PICC line and 4 1/2 years of antibiotics. I suffer confusion, headaches, stiff neck, nausea,and extreme weaknesses and fatigue, nausea and severe brain fog. My head hurts so bad at the back of my head. I would like to be evaluated by the Dr. I have made no improvement in my condition. My skin burns and stings.
Please get back with me.

Betty Gordon
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Betty Gordon

hi doc 😉 very interesting article! around 15 years ago when i was still trying to get a correct diagnosis for my MISDIAGNOSIS of chronic lyme, i had a mri done. it showed a MINI-STROKE with “old blood”. since i was misdx for 35 years, this stroke could have occurred during this time period. is there some type of guideline to determine how long it’s been since any patient had a stroke? thanks doc! betty gordon iowa fan of yours 😉 didn’t get a chance to introduce myself at fall st. paul lda conference!