Winter Yaroslav, Simon Ole J, Spreer Annette, Othman Ahmed E, Altmann Sebastian, Brandt Moritz, Barlinn Kristian, Back Tobias, Civelek Arda, Bach Jan-Philipp, Schiffer Julia, Dresel Christian, Meuth Sven, Bittner Stefan, Groppa Sergiu, Brummer Tobias
Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Department of Neurology, Philipps-University Marburg, Marburg, Germany.
Int J Stroke. 2025 Feb;20(2):205-214. doi: 10.1177/17474930241287326. Epub 2024 Oct 16.
Neuroborreliosis is a tick-borne condition that affects the central and/or peripheral nervous system. Cerebral infarction associated with neuroborreliosis-related vasculitis has been reported in only a handful of cases. Therefore, specific patterns of vascular pathology and prognostic outcome factors are still incompletely understood.
To determine the pattern of vascular pathology and prognostic outcome factors in patients with neuroborreliosis-related vasculitis.
We performed a longitudinal multicenter study between 1997 and 2022 in five academic study sites in Germany with a cumulative reference area of 1,620,000 inhabitants. All patients diagnosed with neuroborreliosis-associated cerebral vasculitis were included. The evaluation of clinical parameters, including NIH Stroke Scale (NIHSS), disability ranking (modified Rankin Scale, mRS), and neuroimaging, was performed at admission as well as after 3 and 12 months. Linear regression analysis was used to identify the independent predictors of recurrent strokes, involvement of posterior circulation, or multiple vessels.
Patients with neuroborreliosis-related vasculitis (n = 51) were relatively young (mean age: 62 years) and displayed a predominance of vascular events within the posterior circulation (60.8%). A history of smoking was linked to recurrent strokes/TIA (64.7% vs. 23.5%; p = 0.006), strokes in multiple territories (100% vs. 35.9%; p < 0.0001), and posterior circulation events (64.5% vs. 30.0%, p = 0.017), whereas other cardiovascular risk factors showed no significant differences. Linear regression analysis corroborated smoking's association with recurrent strokes/ transient ischemic attacks (B: 0.412; p = 0.002), multiple territory strokes/TIA (B: 0.467; p = 0.033), and posterior circulation events (B: 0.317; p = 0.033).
A thorough CSF examination for neuroborreliosis is crucial, especially in younger stroke patients, particularly those experiencing posterior circulation ischemic events. Smoking cessation should be prompted in patients with neuroborreliosis-associated cerebral vasculitis.
神经莱姆病是一种由蜱传播的疾病，可影响中枢和/或周围神经系统。与神经莱姆病相关血管炎相关的脑梗死仅在少数病例中被报道。因此，血管病理的特定模式和预后结果因素仍未完全明确。
确定神经莱姆病相关血管炎患者的血管病理模式和预后结果因素。
1997年至2022年期间，我们在德国的五个学术研究地点进行了一项纵向多中心研究，累计参考区域为162万居民。纳入所有诊断为神经莱姆病相关脑血管炎的患者。在入院时以及3个月和12个月后对临床参数进行评估，包括美国国立卫生研究院卒中量表（NIHSS）、残疾分级（改良Rankin量表，mRS）和神经影像学检查。采用线性回归分析确定复发性卒中、后循环受累或多血管受累的独立预测因素。
神经莱姆病相关血管炎患者（n = 51）相对年轻（平均年龄：62岁），后循环血管事件占主导（60.8%）。吸烟史与复发性卒中/短暂性脑缺血发作（TIA）（64.7%对23.5%；p = 0.006）、多区域卒中（100%对35.9%；p < 0.0001）和后循环事件（64.5%对30.0%，p = 0.017）相关，而其他心血管危险因素无显著差异。线性回归分析证实吸烟与复发性卒中/短暂性脑缺血发作（B：0.412；p = 0.002）、多区域卒中/TIA（B：0.467；p = 0.033）和后循环事件（B：0.317；p = 0.033）相关。
对神经莱姆病进行全面的脑脊液检查至关重要，尤其是在年轻的卒中患者中，特别是那些发生后循环缺血事件的患者。对于神经莱姆病相关脑血管炎患者，应促使其戒烟。
