Neuroborreliosis with cerebrovascular disease causes ischemic stroke in a 12 year old boy

Infections with Borrelia burgdorferi can result in variable neurologic disorders, most frequently facial nerve palsy. In contrast, cerebrovascular problems were only rarely described. We report a 12 year old boy presenting with acute left hemiparesis due to an ischemic stroke caused by neuroborreliosis. The patient suffered a prodromal stage with increasingly severe headaches, fatigue and loss of appetite. Magnetic resonance imaging revealed ischemic infarction of the right capsula interna and lateral thalamus. Anticoagulation with enoxaparin was started, an underlying thrombophilic condition was ruled out. Cerebrospinal fluid studies revealed pleocytosis, disturbed blood-CSF barrier and intrathecal antibody production. A high anti-Borrelia antibody index confirmed the diagnosis of active neuroborreliosis. The initial intravenous treatment with ceftriaxone had to be replaced by oral doxycyclin for 4 weeks due to a drug rash. The clinical recovery was excellent, after 8 weeks the patient's hemiparesis was resolved. Neuroborreliosis has to be considered in the differenzial diagnosis of ischemic stroke in children, and specifically ruled out in cases with cerebrospinal fluid pleocytosis.