Department of Neurology and Neurocritical Care, Saxon Hospital Arnsdorf, Hufelandstr. 15, 01477, Arnsdorf/Dresden, Germany.
J Neurol. 2013 Jun;260(6):1569-75. doi: 10.1007/s00415-013-6831-4. Epub 2013 Jan 18.
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.
神经莱姆病是由于伯氏疏螺旋体系统性感染后影响神经系统而引起的。此前，脑血管炎被认为是神经莱姆病的一种极其罕见的并发症。关于神经莱姆病相关脑血管炎患者的长期预后的数据有限。本研究的目的是对神经莱姆病相关脑血管炎病例进行纵向分析。我们招募了来自德国东部一个地区的三个神经科的所有（n=11）诊断为神经莱姆病相关脑血管炎的患者。纳入标准为突发神经功能缺损、符合脑缺血或脑梗死的磁共振成像（MR）表现、脑脊髓液中针对伯氏疏螺旋体的特异性抗体合成以及脑供血动脉的非动脉粥样硬化性病理。通过数字减影血管造影、磁共振血管造影和/或经颅多普勒超声检测血管炎变化。使用改良 Rankin 量表（mRS）和欧洲五维健康量表（EuroQoL Index）来测量结果。脑血管炎是莱姆病的罕见并发症（流行地区所有病例的 0.3%）。根据临床、影像学和免疫学标准诊断为神经莱姆病相关脑血管炎的 11 例患者中，有 10 例发生缺血性卒中和短暂性脑缺血发作（TIA），7 例患者发生复发性卒中。8 例患者可显示血管炎改变，除 1 例外，所有患者均发生缺血性病变。入院时 mRS 的中位数为 3（范围 0-4），出院时为 2（范围 0-6）。11 例患者中有 8 例后循环受累，2 例患者基底动脉血栓形成，1 例患者在急性期死亡。神经莱姆病可引起脑血管炎基础上的复发性卒中和 TIA。需要腰椎穿刺来发现这种潜在危及生命的疾病。早期识别和充分治疗可能会改善预后。
