German researchers published an article in the Journal of Neurology earlier this year noting the long-term effects of neuroborreliosis – Lyme disease infection in the brain and central nervous system. They detailed how the infection can change the structure and function of the blood vessels in the brain, causing cerebral vasculitis that has been linked to ischaemia and brain infarction (strokes). What’s your risk of a stroke in Lyme disease? We take a look at how rare brain complications of Lyme disease really are.
Just as the actual numbers of Lyme disease cases are unknown due to poor reporting and misdiagnosis, the number of people developing neuroborreliosis and cognitive issues connected to the infection are also undocumented. With cognitive symptoms of Lyme disease so similar to many other diseases and conditions it is easy to see why the infection goes undiagnosed, untreated, or even mistreated. This delay in proper treatment can lead to more extensive brain damage and lasting effects of a normally treatable infection.
To study the impact of Lyme disease in the CNS, researchers in Germany conducted a longitudinal analysis of eleven patients diagnosed with neuroborreliosis in East Germany. They looked at how the disease caused damage to the brain, noting that patients had all suffered sudden neurological deficits, with findings on MRI suggestive of cerebral ischaemia or brain infarction. The patients also had antibodies to borrelia (the Lyme disease bacteria) present in the intrathecal fluid (under the membrane covering the spinal cord and brain) as well as having arterial damage that wasn’t due to atherosclerosis.
Lyme Disease and Stroke – A Rare, but Possible, Complication
Back (et al., 2013) noted that only 0.03% of all cases of Lyme disease involve cerebral vasculitis but ten out of the eleven patients in this research developed ischaemic stroke or transient ischaemic attacks (TIA), while seven had recurrent stroke. Eight patients developed lesions from ischaemia (where blood flow is blocked to an area of tissue, resulting in cell death) with circulation in the back of the brain also affected in eight patients. Two patients had thrombosis (blood clot) in the basilar artery, which led to the death of one patient.
While this complication of Lyme disease appears rare it can cause permanent brain damage and even prove fatal. Early detected, though a lumbar puncture, is required to allow patients to access proper treatment but with the early symptoms of Lyme disease so difficult to spot it is possible that patients will be misdiagnosed with a range of other illnesses first.
Diagnosing Children with CNS Lyme Disease
In another paper, French physicians reported on a case of an eight year old boy with Lyme neuroborreliosis who suffered from cerebral vasculitis and stroke. The boy had ischaemic lesions in the pons and cerebellum, along with narrowing of the basilar artery and abnormalities in the wall of the basilar artery. The child was diagnosed using gadolinium-enhanced magnetic resonance imaging and Lebas, et al (2012), concluded that the technique could be beneficial in diagnosing CNS complications of Lyme disease.
Headaches as a Sign of Neuroborreliosis
In another report, Topakian (et al., 2008) notes that two patients with cerebral vasculitis and stroke due to Lyme disease had a prodromal stage, offering some clues as to early diagnosis. The patients had headaches and signs of enlargement of the meninges (the membranes covering the spinal cord and brain), as well as areas of ischaemia and vasculitis on later vascular imaging. Blood tests for Lyme disease as well as a spinal tap to test the cerebrospinal fluid both confirmed the presence of active infection with borrelia. The patients were treated with ceftriaxone for three weeks, leading to excellent recovery.
Is it Neuroborreliosis?
Although not every headache, neck ache or sudden onset of neck stiffness is caused by serious brain infection, for those living in an area endemic for Lyme disease it may be worth consulting your physician early if you think there’s a possibility that your symptoms are a result of a recent tick bite. It appears that neurological symptoms of Lyme disease are more common in Europe than in the US due to the different strains of the borrelia bacteria found in these areas, but anyone suspecting a CNS infection, especially in children, should seek immediate medical attention. Getting early treatment with antibiotics that can cross the blood-brain barrier are much more effective in minimising the risk of long-term brain damage and stroke from Lyme disease.
Back T, Grünig S, Winter Y, Bodechtel U, Guthke K, Khati D, von Kummer R. Neuroborreliosis-associated cerebral vasculitis: long-term outcome and health-related quality of life. J Neurol. 2013 Jun;260(6):1569-75.
Lebas A, Toulgoat F, Saliou G, Husson B, Tardieu M. Stroke due to lyme neuroborreliosis: changes in vessel wall contrast enhancement. J Neuroimaging. 2012 Apr;22(2):210-2.
Topakian R, Stieglbauer K, Nussbaumer K, Aichner FT. Cerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge. Cerebrovasc Dis. 2008;26(5):455-61.