2026 American Academy of Neurology Abstract Website

Objective:

The review aims to summarize cases of cerebrovascular manifestations of Lyme neuroborreliosis (LNB) to describe patient characteristics, clinical manifestations, diagnostic findings, and treatment outcomes. It seeks to enhance clinician awareness and inform management strategies for underrecognized LNB complications.

Background:

Lyme disease is caused by Borrelia burgdorferi and later stages of the infection can progress to neurological involvement known as LNB. While common manifestations include meningitis and cranial neuropathies, cerebrovascular complications are rare and misdiagnosed.

Design/Methods:

The JBI Manual and PRISMA-ScR guidelines for scoping reviews were followed. Search strategy across 6 databases identified 71 eligible studies. JBI appraisal for bias analysis and descriptive synthesis of data were conducted.

Results:

90 patients were included. Pediatric median age was 12 years (IQR 9–14) and 52 years (IQR 39–60) in adults. Reports originated from Europe [Germany: 23/90 (25.6%)] and United States [15/90 (16.7%)]. Symptom onset ranged from <1 day to 2 years (IQR 1–14 days). Exposure to endemic regions was noted in 63/71(89%) cases, and 32/63(51%) recalled tick exposure. Common neurological findings comprised hemiparesis 46/90(51%), cranial neuropathies—mainly LMN facial palsy[28/90(31%)]—cognitive impairment[23/90(26%)] and ataxia[21/90(23%)]. Common radiological diagnoses were vasculitis[64/89(72%)], ischemic stroke[45/89(51%)], aneurysms[6/89(7%)], and venous sinus thrombosis[5/89(6%)]. Vertebrobasilar[29/90(32%)] and MCA[26/90(29%)] vascular territories were most reported to be affected. CSF showed lymphocytic pleocytosis in 76/81(94%) cases, elevated protein in 52/73(71%) cases, low glucose in 25/52(48%) cases, Borrelia-specific antibodies in 60/67(90%) and positive CSF PCR in [6/20(30%)]. Ceftriaxone was the main therapeutic choice [76/89(76%)], with surgical interventions in 12/90(13%). At median 6-month follow-up, neurological or radiologic improvement were reported in 79/88(90%); mortality was 4/88(4.5%). Major limitation was reliance on case-reports/series which rendered results as exploratory.

Conclusions:

Early recognition of LNB cerebrovascular manifestations is crucial in patients with exposure history. Prompt initiation of antimicrobial therapy and interventional modalities could improve neurological outcomes and morbidity.