Cerebral vasculitis as the clinical manifestation of neuroborreliosis: pattern of vascular pathology and prognostic factors of outcome.

Abstract

BACKGROUND Neuroborreliosis is a tick-borne condition that affects the central and/or peripheral nervous system. Cerebral infarction associated with neuroborreliosis-related vasculitis has been reported in only a handful of cases. Therefore, specific patterns of vascular pathology and prognostic outcome factors in these patients are still incompletely understood. AIMS To determine the pattern of vascular pathology and prognostic outcome factors in patients with neuroborreliosis-related vasculitis. METHODS We performed a longitudinal multicenter study between 1997 and 2022 in five academic study sites in Germany with a cumulative reference area of 1,620,000 inhabitants. All patients diagnosed with neuroborreliosis-associated cerebral vasculitis were included. The evaluation of clinical parameters, including NIH Stroke Scale (NIHSS), disability ranking (modified Rankin Scale, mRS), and neuroimaging with the estimation of patterns of vascular involvement were performed at admission as well as after three and twelve months. Linear regression analysis was used to identify the independent predictors of recurrent strokes, involvement of posterior circulation or multiple vessels. RESULTS Patients with neuroborreliosis-related vasculitis (n=51) were relatively young (mean age: females: 60±11 years; male patients: 60±8 years) and displayed a predominance of vascular events within the posterior circulation (60.8%). A history of smoking was linked to recurrent strokes/TIA (64.7% vs. 23.5%; p=0.006), strokes in multiple territories (100% vs. 35.9%; p<0.0001), and posterior circulation events (64.5% vs. 30.0%, p=0.017), whereas other cardiovascular risk factors showed no significant differences. Linear regression analysis further confirmed smoking's significant association with recurrent strokes/ transient ischemic attacks (B: 0.412; p=0.002), multiple territory strokes/TIA (B: 0.467; p=0.033), and posterior circulation events (B: 0.317; p=0.033). CONCLUSION A thorough CSF examination for neuroborreliosis is crucial, especially in younger stroke patients, particularly those experiencing posterior circulation ischemic events. Smoking-cessation should be prompted in patients with neuroborreliosis-associated cerebral vasculitis.