Zakrzewski Dawid, Tomkiewicz Mateusz, Kubziakowska Wiktoria, Zawadzka Marta, Szymarek Jakub, Mazurkiewicz-Bełdzińska Maria
Department of Developmental Neurology, Medical University of Gdansk, 80-210, Gdansk, Poland.
Neurol Sci. 2025 Jun 19. doi: 10.1007/s10072-025-08296-3.
Neuroborreliosis is a neurological manifestation resulting from bacteria of the Borrelia burgdorferi sensu lato complex infection. This condition presents with a range of heterogeneous symptoms affecting the central and peripheral nervous systems, manifesting with varying frequency in adults and children. In rare cases, the infection may lead to ischemic stroke, however the pathogenesis remains incompletely understood due to its infrequent occurrence. The development of ischemic stroke in these patients is likely mediated by arterial inflammation, leading to critical narrowing of blood vessels and subsequently to ischemia.
This paper presents the case of a 16-year-old patient diagnosed with ischemic stroke. The patient was treated with enoxaparin until exclusion of cardioembolism and vascular dissection. After excluding other potential causes, neuroborreliosis was considered highly probable due to a history of multiple tick bites and elevated titers of antibodies against Borrelia burgdorferi in both blood serum and cerebrospinal fluid. Therefore, the patient received antibiotic therapy. In long-term follow-up, he has shown significant improvement, returning to his pre-stroke level of function.
The lack of literature on the subject contributes to the diagnostic and therapeutic challenges in affected patients. The patient's condition improved as a result of early recognition and prompt initiation of treatment and rehabilitation. It is becoming increasingly important to differentiate paediatric patients with a diagnosis of ischemic stroke also with regard to neuroborreliosis in endemic regions.
神经型莱姆病是由伯氏疏螺旋体狭义复合群细菌感染引起的一种神经表现。这种疾病表现出一系列影响中枢和周围神经系统的异质性症状，在成人和儿童中的表现频率各不相同。在罕见情况下，该感染可能导致缺血性中风，然而由于其发生率低，发病机制仍未完全明确。这些患者缺血性中风的发生可能是由动脉炎症介导的，导致血管严重狭窄并随后引发缺血。
本文介绍了一名16岁被诊断为缺血性中风的患者的病例。该患者接受了依诺肝素治疗，直至排除心源性栓塞和血管夹层。在排除其他潜在病因后，由于有多次蜱叮咬史以及血清和脑脊液中抗伯氏疏螺旋体抗体滴度升高，高度怀疑为神经型莱姆病。因此，该患者接受了抗生素治疗。在长期随访中，他显示出显著改善，恢复到中风前的功能水平。
关于该主题的文献匮乏给受影响患者的诊断和治疗带来了挑战。由于早期识别并及时开始治疗和康复，患者的病情得到了改善。在流行地区，区分诊断为缺血性中风的儿科患者是否患有神经型莱姆病变得越来越重要。
