title: Stroke as an Unusual First Presentation of Lyme Disease.
abstract: Introduction. Lyme neuroborreliosis is a nervous system infection caused by spirochete Borrelia burgdorferi with diverse neurological complications. Stroke due to cerebral vasculitis is a rare consequence of neuroborreliosis and has been described in just a few case reports. Case Presentation. Here, we report the case of a 43-year-old patient who presented with discrete left-sided hemiparesis and amnestic cognitive impairment. Brain magnetic resonance imaging showed a thalamic infarct, and serological and cerebrospinal fluid (CSF) tests confirmed the diagnosis of active neuroborreliosis. The antibiotic treatment with intravenous ceftriaxone for three weeks led to an improvement of the symptoms and remarkable regression of radiological findings, but not to full recovery of the amnestic cognitive disorder. Conclusion. Lyme neuroborreliosis should be suspected in patients with cerebrovascular events without obvious risk factors, especially those living in endemic areas such as northern Europe or those who have been exposed to ticks and those with clinical or radiological findings suggesting Lyme neuroborreliosis, in order to establish the diagnosis and start a proper antibiotic therapy.
authors.affiliation: Department of Neurology, St. Josef Hospital, The Academic Hospital of Duisburg-Essen University, Mülheimer Strasse 83, 46045 Oberhausen, Germany.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Almoussa
authors.affiliation: Department of Neurology, St. Josef Hospital, The Academic Hospital of Duisburg-Essen University, Mülheimer Strasse 83, 46045 Oberhausen, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Goertzen
authors.affiliation: Department of Neurology, St. Josef Hospital, The Academic Hospital of Duisburg-Essen University, Mülheimer Strasse 83, 46045 Oberhausen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fauser
authors.affiliation: Department of Neurology, St. Josef Hospital, The Academic Hospital of Duisburg-Essen University, Mülheimer Strasse 83, 46045 Oberhausen, Germany.
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Zimmermann