Neuroborreliosis as a Cause of Acute Ischemic Stroke in a 13-Year-Old Patient

Acute ischemic stroke is a rare condition in the pediatric population. This case highlights the importance of considering neuroborreliosis as a potential cause of stroke in children, emphasizing the role of early diagnosis and appropriate treatment in preventing long-term sequelae. We present the case of a 13-year-old girl who was admitted with left-sided central facial nerve paresis. She had a six-month history of recurrent tension headaches and unintentional weight loss. Brain MRI revealed an ischemic lesion in the right thalamus and internal capsule, with additional findings in the left thalamus and cerebellar hemispheres on follow-up imaging. The diagnostic workup revealed positive Borrelia burgdorferi antibodies in both the cerebrospinal fluid and serum, confirming neuroborreliosis. Causal treatment was initiated with a third-generation cephalosporin, resulting in significant clinical improvement. Pediatric acute ischemic stroke in the course of secondary vasculitis on an infectious background appears to be the leading cause of stroke in children, which underscores the need for a thorough diagnostic evaluation targeting treatable infectious etiologies in all pediatric stroke cases. Early identification and causal treatment of such conditions, particularly neuroborreliosis, significantly improve neurological outcomes and increase the likelihood of full recovery. Therefore, potential infectious causes should not only be actively investigated but also considered when initiating empirical treatment. There is a necessity of maintaining high clinical vigilance in symptomatic patients from endemic regions presenting solely with positive Borrelia IgG serology, as such a profile does not exclude the presence of active and potentially severe neuroborreliosis.