Case report of ischemic stroke in a child secondary to neuroborreliosis

Abstract

Background: Neuroborreliosis is a neurological manifestation resulting from bacteria of the Borrelia burgdorferi sensu lato complex infection. This condition presents with a range of heterogeneous symptoms affecting the central and peripheral nervous systems, manifesting with varying frequency in adults and children. In rare cases, the infection may lead to ischemic stroke, however the pathogenesis remains incompletely understood due to its infrequent occurrence. The development of ischemic stroke in these patients is likely mediated by arterial inflammation, leading to critical narrowing of blood vessels and subsequently to ischemia.

Case presentation: This paper presents the case of a 16-year-old patient diagnosed with ischemic stroke. The patient was treated with enoxaparin until exclusion of cardioembolism and vascular dissection. After excluding other potential causes, neuroborreliosis was considered highly probable due to a history of multiple tick bites and elevated titers of antibodies against Borrelia burgdorferi in both blood serum and cerebrospinal fluid. Therefore, the patient received antibiotic therapy. In long-term follow-up, he has shown significant improvement, returning to his pre-stroke level of function.

Conclusions: The lack of literature on the subject contributes to the diagnostic and therapeutic challenges in affected patients. The patient's condition improved as a result of early recognition and prompt initiation of treatment and rehabilitation. It is becoming increasingly important to differentiate paediatric patients with a diagnosis of ischemic stroke also with regard to neuroborreliosis in endemic regions.

Keywords: Childs neuroborreliosis; Ischemic stroke in children; Lyme disease; Neuroborreliosis; Stroke in children.