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Neuroborreliosis-associated cerebral vasculitis: long-term outcome and health-related quality of life

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Abstract

Neuroborreliosis affects the nervous system after systemic infection with the spirochete Borrelia burgdorferi. Previously, cerebral vasculitis has been regarded as an extremely rare complication of neuroborreliosis. The data on the long-term outcome in patients with cerebral vasculitis due to neuroborreliosis are limited. The objective of this study was to perform a longitudinal analysis of cases of neuroborreliosis-associated cerebral vasculitis. We recruited all patients (n = 11) diagnosed with neuroborreliosis-associated in three neurological departments in an East German region. Inclusion criteria were sudden neurological deficits, magnetic resonance (MR) imaging findings that conform to cerebral ischemia or brain infarction, intrathecal synthesis of borrelia-specific antibodies, and non-atherosclerotic pathology of brain supplying arteries. Vasculitic changes were detected by digital subtraction angiography, MR angiography and/or transcranial Doppler ultrasound. Outcomes were measured by the modified Rankin scale (mRS) and EuroQoL Index. Cerebral vasculitis is a rare complication of Lyme disease (0.3 % of all cases in the endemic area). Ten out of 11 patients diagnosed with neuroborreliosis-associated vasculitis cerebral vasculitis using clinical, radiological and immunological criteria developed ischemic stroke or transient ischemic attacks (TIA), 7 patients had recurrent stroke. Vasculitic alterations could be demonstrated in 8 patients that all except one developed ischemic lesions. The median mRS was 3 (range 0–4) at admission and 2 (range 0–6) at discharge. The posterior circulation was affected in 8 of 11 patients; thrombosis of the basilar artery was detected in 2 patients, one died in the acute stage. Neuroborreliosis can cause recurrent stroke or TIA on the basis of cerebral vasculitis. Lumbar puncture is needed for detection of this potentially life-threatening condition. Early recognition and adequate therapy would possibly improve outcome.

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Authors and Affiliations

  1. Department of Neurology and Neurocritical Care, Saxon Hospital Arnsdorf, Hufelandstr. 15, 01477, Arnsdorf/Dresden, Germany

    Tobias Back, Steffi Grünig & Diana Khati

  2. Department of Neurology, Philipps-University Marburg, Marburg, Germany

    Yaroslav Winter

  3. Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Ulf Bodechtel

  4. Department of Neurology, Municipal Hospital Görlitz, Görlitz, Germany

    Kersten Guthke

  5. Department of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Rüdiger von Kummer

Authors
  1. Tobias Back
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  2. Steffi Grünig
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  3. Yaroslav Winter
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  4. Ulf Bodechtel
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  5. Kersten Guthke
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  6. Diana Khati
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  7. Rüdiger von Kummer
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Correspondence to Yaroslav Winter.

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Back, T., Grünig, S., Winter, Y. et al. Neuroborreliosis-associated cerebral vasculitis: long-term outcome and health-related quality of life. J Neurol 260, 1569–1575 (2013). https://doi.org/10.1007/s00415-013-6831-4

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  • DOI: https://doi.org/10.1007/s00415-013-6831-4

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