Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Sep;46(9):4497-4503.
doi: 10.1007/s10072-025-08296-3. Epub 2025 Jun 19.

Case report of ischemic stroke in a child secondary to neuroborreliosis

Dawid Zakrzewski  1 , Mateusz Tomkiewicz  1 , Wiktoria Kubziakowska  1 , Marta Zawadzka  2 , Jakub Szymarek  1 , Maria Mazurkiewicz-Bełdzińska  1
Affiliations
Case Reports

Case report of ischemic stroke in a child secondary to neuroborreliosis

Dawid Zakrzewski et al. Neurol Sci. 2025 Sep.

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.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written consent for the publication of the patient's clinical data and clinical images was obtained from the patient and the patient's parent. A copy of the consent form is available for review by the editors of this journal. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
MRI of the head image. In the ventral central-left-side part of the medulla oblongata, in its middle section, an area of ​​increased signal with features of diffusion restriction (size 9 × 6 mm) corresponding to an ischemic focus is visible
Fig. 2
Fig. 2
Serodiagnosis of Lyme disease with CFS (collections of Central Clinical Laboratory, University Clinical Center in Gdańsk)
Fig. 3
Fig. 3
MRI of the head image. Small area (size 5 × 2.5 mm) of ​​discreetly increased T2WI/FLAIR signal, without diffusion restriction, without pathological contrast enhancement corresponding to gliosis after an ischemic episode
Fig. 4
Fig. 4
Summary timeline
See this image and copyright information in PMC

References

    1. Mead P (2022S) Epidemiology of Lyme disease. Infect Dis Clin North Am 36(3):495–521. 10.1016/j.idc.2022.03.004 - PubMed
    1. Steinbrink A, Brugger K, Margos G, Kraiczy P, Klimpel S (2022) The evolving story of Borrelia burgdorferi sensu lato transmission in Europe. Parasitol Res 121(3):781–803. 10.1007/s00436-022-07445-3 - PMC - PubMed
    1. Neelakanta G, Li X, Pal U, Liu X, Beck DS, DePonte K, Fish D, Kantor FS, Fikrig E (2007) Outer surface protein B is critical for Borrelia burgdorferi adherence and survival within Ixodes ticks. PLoS Pathog 3(3):e33. 10.1371/journal.ppat.0030033 - PMC - PubMed
    1. Cardenas-de la Garza JA, De la Cruz-Valadez E, Ocampo-Candiani J, Welsh O (2019) Clinical spectrum of Lyme disease. Eur J Clin Microbiol Infect Dis 38(2):201–208. 10.1007/s10096-018-3417-1 - PubMed
    1. Oschmann P, Dorndorf W, Hornig C, Schäfer C, Wellensiek HJ, Pflughaupt KW (1998) Stages and syndromes of neuroborreliosis. J Neurol 245:262–272. 10.1007/s004150050216 - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources