Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis-Interventional Management Approach and Literature Review

Burak Han Akkurt; Hermann Kraehling; Nabila Gala Nacul; Mohamed Elsharkawy; Antje Schmidt-Pogoda; Jens Minnerup; Christian Paul Stracke; Wolfram Schwindt

doi:10.3390/brainsci13101388

Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis-Interventional Management Approach and Literature Review

Brain Sci. 2023 Sep 29;13(10):1388. doi: 10.3390/brainsci13101388.

Authors

Burak Han Akkurt¹, Hermann Kraehling^{1

2}, Nabila Gala Nacul¹, Mohamed Elsharkawy², Antje Schmidt-Pogoda³, Jens Minnerup³, Christian Paul Stracke^{2

4}, Wolfram Schwindt²

Affiliations

¹ Department of Radiology, University Hospital Muenser, Westfalian Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
² Department of Interventional Neuroradiology, Westfalian Wilhelms-University Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
³ Department of Neurology, Westfalian Wilhelms-University Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
⁴ Clinic and Policlinic for Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

Abstract

Objective: In rare cases, Lyme neuroborreliosis (LNB) can induce cerebral vasculitis leading to severe stenosis of the cerebral vasculature and consecutive ischemia. Therapy is based on anti-biotic treatment of the tick-borne disease, whereas interventional therapeutic options have not been assessed yet.

Material and methods: We report on a patient with LNB and concomitant stenoses and progressive and fatal vasculitis of the cerebral vessels despite all therapeutic efforts by the departments of neurology and interventional neuroradiology. In this context, we also conducted a literature review on endovascular treatment of LNB-associated cerebral ischemia.

Results: A 52-year-old female presented with transient neglect and psychomotor slowdown (initial NIHSS = 0). MRI and serology led to the diagnosis of basal meningitis due to LNB with vasculitis of cerebral arteries. Despite immediate treatment with antibiotics and steroids, neurologic deterioration (NIHSS 8) led to an emergency angiography on day 2 after admission. Hemodynamically relevant stenoses of the MCA were treated via spasmolysis and PTA, leading to almost complete neurological recovery. Despite intensified medical treatment, the vasculitis progressed and could only be transiently ameliorated via repetitive spasmolysis. On day 19, she again presented with significant neurologic deterioration (NIHSS 9), and PTA and stenting of the nearly occluded MCA were performed with a patent vessel, initially without hemorrhagic complications. Despite all therapeutic efforts and preserved stent perfusion, vasculitis worsened and the concurrent occurrence of subdural hemorrhage led to the death of the patient.

Conclusion: Neuroradiological interventions, i.e., spasmolysis, PTA, and, if necessary, stenting, can and should be considered in cases of LNB-induced vasculitis and stroke that are refractory to best medical treatment alone.

Key point: Neuroradiological interventions can be considered in patients with vascular complications of Lyme neuroborreliosis as an additional extension of the primary drug therapy.

Keywords: Lyme neuroborreliosis; ballon-angioplasty; coated stents; endovascular treatment; intracranial stenting; ischemic stroke; neuroradiological intervention; vasculitis; vasospasmolysis.

Publication types

Review

Grants and funding

The authors declare that no funds, grants or other support were received during the preparation of this manuscript. We acknowledge support from the Open Access Publication Fund of the University of Muenster.