Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review

As part of an ongoing study aiming to define the clinical spectrum of neuro borreliosis in childhood, we have identified four patients with unusual cli nical manifestations. Two patients suffered from a primarily chronic form o f neuroborreliosis and displayed only non-specific symptoms. An 11 year old boy presented with long standing symptoms of severe weight loss and chroni c headache, while the other patient had pre-existing mental and motor retar dation and developed seizures and failure to thrive. Two further children w ho presented with acute hemiparesis as a result of cerebral ischaemic infar ction had a cerebrovascular course of neuroborreliosis. One was a 15 year o ld girl; the other, a 5 year old boy, is to our knowledge the youngest pati ent described with this course of illness. Following adequate antibiotic tr eatment, all patients showed substantial improvement of their respective sy mptoms. Laboratory and magnetic resonance imaging findings as well as clini cal course are discussed and relevant literature is reviewed.