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

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...

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Autores principales: Akkurt, Burak Han, Kraehling, Hermann, Nacul, Nabila Gala, Elsharkawy, Mohamed, Schmidt-Pogoda, Antje, Minnerup, Jens, Stracke, Christian Paul, Schwindt, Wolfram
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605510/
https://www.ncbi.nlm.nih.gov/pubmed/37891757
http://dx.doi.org/10.3390/brainsci13101388
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author Akkurt, Burak Han
Kraehling, Hermann
Nacul, Nabila Gala
Elsharkawy, Mohamed
Schmidt-Pogoda, Antje
Minnerup, Jens
Stracke, Christian Paul
Schwindt, Wolfram
author_facet Akkurt, Burak Han
Kraehling, Hermann
Nacul, Nabila Gala
Elsharkawy, Mohamed
Schmidt-Pogoda, Antje
Minnerup, Jens
Stracke, Christian Paul
Schwindt, Wolfram
author_sort Akkurt, Burak Han
collection PubMed
description 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.
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spelling pubmed-106055102023-10-28 Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review Akkurt, Burak Han Kraehling, Hermann Nacul, Nabila Gala Elsharkawy, Mohamed Schmidt-Pogoda, Antje Minnerup, Jens Stracke, Christian Paul Schwindt, Wolfram Brain Sci Review 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. MDPI 2023-09-29 /pmc/articles/PMC10605510/ /pubmed/37891757 http://dx.doi.org/10.3390/brainsci13101388 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Akkurt, Burak Han
Kraehling, Hermann
Nacul, Nabila Gala
Elsharkawy, Mohamed
Schmidt-Pogoda, Antje
Minnerup, Jens
Stracke, Christian Paul
Schwindt, Wolfram
Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title_full Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title_fullStr Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title_full_unstemmed Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title_short Vasculitis and Ischemic Stroke in Lyme Neuroborreliosis—Interventional Management Approach and Literature Review
title_sort vasculitis and ischemic stroke in lyme neuroborreliosis—interventional management approach and literature review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605510/
https://www.ncbi.nlm.nih.gov/pubmed/37891757
http://dx.doi.org/10.3390/brainsci13101388
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