Abstract Details

Title When Lyme Disease Strikes the Brain: A Scoping Review of Cerebrovascular Manifestations of Neuroborreliosis

Topic Infectious Disease

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 3-009

Objective

The review aims to summarize cases of cerebrovascular manifestations of Lyme neuroborreliosis (LNB) to describe patient characteristics, clinical manifestations, diagnostic findings, and treatment outcomes. It seeks to enhance clinician awareness and inform management strategies for underrecognized LNB complications.

Background

Lyme disease is caused by Borrelia burgdorferi and later stages of the infection can progress to neurological involvement known as LNB. While common manifestations include meningitis and cranial neuropathies, cerebrovascular complications are rare and misdiagnosed.

Design/Methods

The JBI Manual and PRISMA-ScR guidelines for scoping reviews were followed. Search strategy across 6 databases identified 71 eligible studies. JBI appraisal for bias analysis and descriptive synthesis of data were conducted.

Results 90 patients were included. Pediatric median age was 12 years (IQR 9–14) and 52 years (IQR 39–60) in adults. Reports originated from Europe [Germany: 23/90 (25.6%)] and United States [15/90 (16.7%)]. Symptom onset ranged from <1 day to 2 years (IQR 1–14 days). Exposure to endemic regions was noted in 63/71(89%) cases, and 32/63(51%) recalled tick exposure. Common neurological findings comprised hemiparesis 46/90(51%), cranial neuropathies—mainly LMN facial palsy[28/90(31%)]—cognitive impairment[23/90(26%)] and ataxia[21/90(23%)]. Common radiological diagnoses were vasculitis[64/89(72%)], ischemic stroke[45/89(51%)], aneurysms[6/89(7%)], and venous sinus thrombosis[5/89(6%)]. Vertebrobasilar[29/90(32%)] and MCA[26/90(29%)] vascular territories were most reported to be affected. CSF showed lymphocytic pleocytosis in 76/81(94%) cases, elevated protein in 52/73(71%) cases, low glucose in 25/52(48%) cases, Borrelia-specific antibodies in 60/67(90%) and positive CSF PCR in [6/20(30%)]. Ceftriaxone was the main therapeutic choice [76/89(76%)], with surgical interventions in 12/90(13%). At median 6-month follow-up, neurological or radiologic improvement were reported in 79/88(90%); mortality was 4/88(4.5%). Major limitation was reliance on case-reports/series which rendered results as exploratory.

Conclusions

Early recognition of LNB cerebrovascular manifestations is crucial in patients with exposure history. Prompt initiation of antimicrobial therapy and interventional modalities could improve neurological outcomes and morbidity.

Authors/Disclosures
Dhanikha Sridevi Vasanthakumar, MBBS PRESENTER	Dr. Sridevi Vasanthakumar has nothing to disclose.
Shwetha Shenod, MBBS	Ms. Shenod has nothing to disclose.
Annie S. Daniel, MBBS (Department of Neurology , Hospital for Special Care , New Britain , Ct)	Dr. Daniel has nothing to disclose.

��ɫ��

��ɫ��