Neuroboreliosis with pronounced cerebral vasculitis and multiple brain infarcts

We report on a patient who suffered from borreliosis-induced severe cerebra l vasculitis accompanied by multiple cerebral infarctions leading to hemipa resis, hemianopsia and reduced consciousness. Despite antibiotic and immuno suppressive therapy with ceftriaxon and prednisolone the patients condition deteriorated. Cerebral angiography showed multiple stenoses of large arter ies of the posterior circulation and ubiquitous irregularities of smalt ves sel walls. General reduced perfusion reflected an increased peripheral resi stance. After 4 weeks of additional immunosuppressive treatment with cyclop hosphamide the neurological status and angiographic findings improved drama tically.