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Stroke Teenager with Stroke Symptoms Actually Had Lyme Disease

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Stroke Teenager with stroke symptoms actually had Lyme disease Source-https://www.sciencedaily.com/releases/2015/03/150302182428.htm A Swiss teenager, recently returned home from a discotheque, came to the emergency department with classic sudden symptoms of stroke, only to be diagnosed with Lyme disease. The highly unusual case presentation was published online in Annals of Emergency Medicine. "Everything about her symptoms indicated stroke: speech deficits, poor comprehension and right-sided face and arm weakness, so we considered treating her with clot-busting drugs" said lead study author Arseny Sokolov, MD, of the Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland. "But a 16 year-old having a stroke, while not unheard of, would be quite rare so we looked at other possibilities and found Lyme." Brain imaging was not suggestive of stroke either, but revealed circumscribed brain dysfunction. The treatment team performed a spinal tap. The patient's spinal fluid showed elevated white blood cell counts and Lyme neuroborreliosis was diagnosed, so the treatment team began a course of antibacterial and antiviral agents. The patient improved immediately after treatment began. "The imaging findings for the first time demonstrate acute brain dysfunction that appears to be directly related to neuroborreliosis" said senior co-author Renaud Du Pasquier, MD, neurology chairman at the Centre Hospitalier Universitaire Vaudois in Lausanne. "It may point out future perspectives for research on the underlying mechanisms." Lyme disease is caused by Borrelia burgdorferi bacteria, and is known as "the great imitator," as its symptoms can mimic so many other diseases. Many patients have Lyme for a long time before a proper diagnosis is rendered. When that happens, serious long-term complications are the result. "The uncommon set of symptoms our patient had show why Lyme is a 'chameleon disease' of the emergency department," said Dr. Sokolov. "Furthermore, the patient had no history of tick bite. This curious case just shows the careful detective work that is involved in such a large portion of emergency medicine." Reference: Acute Lyme Neuroborreliosis With Transient Hemiparesis and Aphasia Arseny A. Sokolov, MD, Reto Lienhard, MSc, Renaud Du Pasquier, MD, Véronique Erard, MD DOI: http://dx.doi.org/10.1016/j.annemergmed.2015.01.011 ABSTRACT Nervous system involvement in Lyme disease often mimics other conditions and thus represents a diagnostic challenge, especially in an emergency department setting. We report a case of a female teenager presenting with sudden-onset aphasia and transient right-sided faciobrachial hemiplegia, along with headache and agitation. Ischemia, vasculitis, or another structural lesion was excluded by brain imaging. Toxicologic evaluation results were negative. Cerebral perfusion computed tomography and electroencephalography showed left parietotemporal brain dysfunction. Lumbar puncture result, although atypical, suggested bacterial infection and intravenous ceftriaxone was initiated. Finally, microbiological cerebrospinal fluid analysis revealed Lyme neuroborreliosis, showing specific intrathecal antibody production and high level of C-X-C motif chemokine 13. The patient rapidly recovered. To our knowledge, this report for the first time illustrates that acute-onset language and motor symptoms may be directly related to Lyme neuroborreliosis. Neuroborreliosis may mimic other acute neurologic events such as stroke and should be taken into diagnostic consideration even in the absence of classic symptoms and evolution. Further scientific literature Pediatr Neurol. 2015 Jan;52(1):107-9. doi: 10.1016/j.pediatrneurol.2014.10.009. Epub 2014 Oct 16. A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging. Ewers EC1, Dennison DH2, Stagliano DR3. Author information Abstract BACKGROUND: Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic meningitis and only rarely is associated with cranial polyneuritis. PATIENT DESCRIPTION: We present a 15-year-old with tinnitus, hearing loss, and facial nerve palsy in the setting of acute, severe right arm pain and a several week history of malaise and headache. Lumbar puncture was notable for lymphocytic pleocytosis. Serologic testing demonstrated positive Lyme antibody and a positive immunoglobulin M Western blot. Immunofluorescent assay of cerebrospinal fluid was also positive for anti-Lyme immunoglobulin M. Audiologic testing revealed mixed, right-sided hearing loss. Neuroimaging demonstrated cranial polyneuritis and right-sided cochlear inflammation. The patient was treated with parenteral ceftriaxone with resolution of his symptoms at close follow-up. DISCUSSION: Neuroborreliosis with radiculopathy, lymphocytic meningitis, and cranial polyneuritis is a rare presentation of pediatric Lyme disease. Additionally, cochlear inflammation along with cranial nerve VIII inflammation may contribute to hearing loss in patients with neuroborreliosis. Wien Klin Wochenschr. 2015 Jan;127(1-2):65-7. doi: 10.1007/s00508-014-0622-5. Epub 2014 Oct 24. Cerebral sinuvenous thrombosis: a rare complication of Lyme neuroborreliosis. Blažina K1, Miletić V, Relja M, Bažadona D. Author information Abstract Association between neuroborreliosis and cerebral sinuvenous thrombosis is rare, and it can be made only when other, more common predisposing conditions are excluded. In the case of increased intracranial pressure and confirmed neuroborreliosis, early magnetic resonance venography and combination of antibacterial therapy with anticoagulation provide better long-term outcome. We present a case of a patient with cerebral sinuvenous thrombosis who was first treated for neuroborreliosis. Infect Dis (Lond). 2015 Jan;47(1):1-6. doi: 10.3109/00365548.2014.961544. Epub 2014 Oct 24. Vasculitis and stroke due to Lyme neuroborreliosis - a review. Zajkowska J1, Garkowski A, Moniuszko A, Czupryna P, Ptaszyńska-Sarosiek I, Tarasów E, Ustymowicz A, Łebkowski W, Pancewicz S. Author information Erratum in • Corrigendum. [Infect Dis (Lond). 2015] Abstract Abstract Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicion is required in patients who live or have traveled to areas with high prevalence of tick-borne diseases, and in the case of stroke-like symptoms of unknown cause in patients without cardiovascular risk factors. In this review, we also present four illustrative cases of vasculitis and stroke-like manifestations of LNB. J Child Neurol. 2015 Aug;30(9):1226-9. doi: 10.1177/0883073814552104. Epub 2014 Oct 14. Stroke-like Phenomena Revealing Multifocal Cerebral Vasculitis in Pediatric Lyme Neuroborreliosis. Kurian M1, Pereira VM2, Vargas MI2, Fluss J3. Author information Abstract Stroke-like presentation in Lyme neuroborreliosis is rare in the pediatric age group. We report a previously healthy 12- year-old boy who presented with acute left hemiparesis and meningeal signs. Neuroimaging failed to reveal any cerebral infarction but demonstrated a multifocal cerebral vasculitis involving small, medium and large-sized vessels affecting both the anterior and posterior circulation. Concentric contrast enhancement of the basilar artery was also observed. Further investigations and laboratory findings were consistent with Lyme neuroborreliosis. A rapidly favorable clinical outcome was obtained with appropriate antibiotic treatment along with antiaggregants and steroids. Lyme neuroborreliosis should be considered in the diagnostic differential, not only in adults but also among children, especially in the context of an unexplained cerebral vasculitis. Cerebrovasc Dis. 2013;35(2):184-5. doi: 10.1159/000346597. Epub 2013 Feb 21. Transient ischaemic attack in a 5-year-old girl due to focal vasculitis in neuroborreliosis. Kohns M1, Karenfort M, Schaper J, Laws HJ, Mayatepek E, Distelmaier F. J Pediatr. 2016 Mar;170:334-334.e1. doi: 10.1016/j.jpeds.2015.11.077. Epub 2016 Jan 6. Lyme Neuroborreliosis: A Potentially Preventable Cause of Stroke. Allen NM1, Jungbluth H1. Cerebrovasc Dis. 2008;26(5):455-61. doi: 10.1159/000155982. Epub 2008 Sep 23. Cerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge. Topakian R1, Stieglbauer K, Nussbaumer K, Aichner FT. Author information Abstract We report on 2 patients with cerebral vasculitis and stroke due to Lyme neuroborreliosis (LNB). Both patients had a prodromal stage involving headaches, and showed meningeal enhancement in addition to ischemic infarctions on brain magnetic resonance imaging and diffuse vasculitis on vascular imaging. Serological and cerebrospinal (CSF) fluid studies confirmed the diagnosis of active LNB. Ceftriaxone for 3 weeks led to an excellent recovery and improvements in the CSF examination findings. Stroke physicians should be aware of this rare presentation of LNB. A review of the current knowledge on cerebral vasculitis due to LNB is provided. Acta Neurol Belg. 2008 Sep;108(3):103-6. Acute ischaemic pontine stroke revealing lyme neuroborreliosis in a
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