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Spontaneous brain hemorrhage associated with Lyme neuroborreliosis
M Seijo Martínez1, J Grandes Ibáñez, J Sánchez Herrero
1Servicio de Neurología, Complexo Hospitalario de Pontevedra, Lóureiro Crespo, s/n 36001 Pontevedra. mseijom@meditex.es
Abstract:
We present the case of a patient with late neuroborreliosis and a spontaneous temporal lobe hemorrhage. Although ischemic stroke and subarachnoid hemorrhage have been reported in association with Lyme disease, intraparenchymal brain hemorrhage has not been previously described in the course of this disease. The patient is a 48-year old male with a progressive spastic paraparesis of months' duration who presented acute headache, confusion, severe left hemiparesis with sensory deficit and homonymous hemianopsia. A cranial computed tomography scan showed an extensive right temporal lobe hemorrhage with subarachnoid invasion. Brain angiographic and angio-magnetic resonance imaging studies excluded hemorrhage-predisposing vascular abnormalities. Cerebrospinal fluid (CSF) studies disclosed mononuclear pleocytosis with elevated protein levels. Both serum and CSF anti-Borrelia titers were significantly increased, and serum Western Blot showed bands to protein 34 (ops B), 57, 59 and 62. The patient was treated with ceftriaxone for 4 weeks, with a favorable outcome. It is suspected that cause of the hemorrhage was parenchymatous Lyme-associated vascular damage and/or microaneurysmatic rupture.
Insights
This case study details a rare instance of spontaneous temporal lobe hemorrhage in a patient with late neuroborreliosis (Lyme disease). The findings suggest Lyme-associated vascular damage may cause such hemorrhages.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Lyme disease, a tick-borne illness, can affect the nervous system (neuroborreliosis).
- While ischemic stroke and subarachnoid hemorrhage are known complications, intraparenchymal brain hemorrhage is not previously documented.
- Late neuroborreliosis presents diverse neurological manifestations.
Observation:
- A 48-year-old male with progressive spastic paraparesis presented with acute headache, confusion, hemiparesis, and hemianopsia.
- Cranial CT revealed a right temporal lobe hemorrhage with subarachnoid invasion.
- Cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and elevated protein levels, with positive anti-Borrelia titers in serum and CSF.
Findings:
- Brain imaging excluded vascular malformations as the cause of hemorrhage.
- Positive serum Western Blot confirmed Borrelia infection.
- The patient received a 4-week course of ceftriaxone with a favorable outcome.
Implications:
- This case highlights spontaneous intraparenchymal brain hemorrhage as a potential, albeit rare, complication of late neuroborreliosis.
- Lyme-associated vascular damage or microaneurysmal rupture is suspected as the underlying mechanism.
- Further research is warranted to understand the neurovascular complications of Lyme disease.