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  • Title: A case report of unilateral cerebral vasculitis in adults: keep in mind Lyme neuroborreliosis.
    Author: Riescher S, Dos Santos A, Lecomte R, Lenoble C, Guillon B.
    Journal: BMC Infect Dis; 2023 May 04; 23(1):283. PubMed ID: 37142957.
    Abstract:
    BACKGROUND: Lyme neuroborreliosis (LNB), due to infection of the nervous system by the spirochete Borrelia burgdorferi, occurs in 15% of Lyme disease cases. However, neurovascular involvement is uncommon, especially recurrent stroke related to cerebral vasculitis in the absence of CSF pleocytosis. CASE PRESENTATION: We report the case of a 58-year-old man without any medical history who exhibited recurrent strokes in the same vascular territory (left internal carotid). Multiple biological screening, neuroimaging methods, and cardiovascular examinations failed to provide a diagnosis and treatment that could have prevented recurrences. Finally, B. burgdorferi sensu lato serology testing in blood and cerebrospinal fluid enabled diagnosis of LNB, in relation to a cerebral vasculitis. The patient experienced no further stroke after four weeks of doxycycline treatment. CONCLUSION: B. burgdorferi central nervous system infection must be considered in case of unexplained recurrent and/or multiple strokes, especially if cerebral vasculitis is suspected or demonstrated on neuroimaging.
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