Exploring Cerebrovascular Manifestations of Neuroborreliosis: A Scoping Review

BACKGROUND AND OBJECTIVES: Lyme disease is zoonotic infection transmitted by Borrelia burgdorferi and, if left undiagnosed, can present in later stages with neurological manifestations. This review aims to consolidate evidence on stroke-like or similar cerebrovascular outcomes of Lyme neuroborreliosis (LNB) to aid early recognition and treatment. METHODS: A comprehensive search resulted in 90 patients meeting European Federation of Neurological Societies/Infectious Diseases Society of America/ American Academy of Neurology/American College of Rheumatology (EFNS/IDSA/AAN/ACR) criteria for LNB with radiologically or serologically confirmed cerebrovascular involvement. Data were charted descriptively. RESULTS: Median age was 12 years among children and 52 years in adult cases. Tick exposure was reported in 89% of cases. Presentations included hemiparesis (51%), cranial-nerve palsy (38%; Lower Motor Neuron (LMN) facial 31%), and cognitive changes (26%). Common imaging findings were vasculitis (72%) and ischaemic stroke (51%), mainly in the cortical (56%) area. Cerebrospinal fluid (CSF) lymphocytic pleocytosis (median 73 cells/µL) with presence of intrathecal Borrelia Immunoglobulin G (IgG) appeared in the majority of cases. Antibiotics (mainly ceftriaxone) were used in 85% of cases and interventional management in 13% of cases. Ninety percent of cases improved after 6 months of treatment. Mortality and persistent tetraplegia were reported in 5% and 3% of cases, respectively. CONCLUSIONS: LNB should be suspected in cases of cryptogenic stroke from endemic areas. Reduction in CSF pleocytosis with intrathecal Borrelia antibodies could predict a favorable antibiotic response, although some refractory cases were observed to improve only with interventional management. Prompt diagnosis and management can affect morbidity and mortality.