Lyme disease is a zoonosis caused by spirochetes of the genus Borrelia, presenting with a broad spectrum of clinical manifestations. This heterogeneity may hinder diagnosis, particularly in regions with low prevalence.

We present the case of a 65-year-old woman who attended the emergency department with a 24-hour history of diplopia upon awakening, without other neurological focal signs. Neuroborreliosis was diagnosed after identifying a history of travel to an endemic area and compatible cutaneous manifestations. Clinical progression, together with serological confirmation, enabled early diagnosis and initiation of appropriate antibiotic therapy, resulting in complete resolution of symptoms.

This case highlights the importance of including Lyme disease in the differential diagnosis of patients with any neurological focal signs and a history of travel to endemic regions, even in the absence of recalled tick bites or classical manifestations. Early detection and timely treatment are crucial to prevent chronic and disabling complications.

Acute basilar artery occlusion (BAO) correlates with high risks of disability and mortality, and the best imaging and treatment strategies for BAO remain controversial. This study evaluated the association between baseline imaging, clinical variables, and clinical outcomes of patients with BAO undergoing endovascular therapy (EVT).

Data from 75 patients with BAO who had EVT at a single center were retrospectively analyzed. Baseline National Institutes of Health Stroke Scale (NIHSS) scores, clinical baseline data, and various known scores and perfusion deficit volumes on non-contrast computed tomography (NCCT), CT angiography source images (CTA-SI), and CT perfusion (CTP) were collected to explore effective predictive factors for prognosis. The functional outcome of the analysis was satisfactory (90-day modified Rankin Scale score ≤3). Predictors of functional outcomes were assessed through receiver operating characteristic analyses and binary logistic regression.

Among the 75 patients who fulfilled the inclusion criteria, 29 achieved a good outcome (39%) and 46 (61%) achieved a poor outcome. The Critical Area Perfusion Score (CAPS), pons midbrain index (PMI), time to maximum (Tmax) >6 s, Tmax >10 s, and reduction in CBF compared with normal brain tissue (rCBF) <30%, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) were independent predictors of favorable prognosis. The CAPS was the best predictor of good clinical outcomes, with an area under the curve of 0.862 (95% confidence interval [CI], 0.772–0.952). Combined diagnosis with the baseline NIHSS score improved the prognosis prediction accuracy.

In patients with stroke that resulted in BAO after EVT, CAPS, PMI, Tmax >6 s, Tmax >10 s, rCBF <30% volume, and CBV pc-ASPECTS were excellent predictors of higher risk of disability and mortality. Furthermore, CAPS had the best accuracy, and overall predictive value could be improved when combined with the baseline NIHSS score for diagnosis.

Moyamoya angiopathy is a cerebrovascular disease characterized by progressive stenosis of the intracranial internal carotid arteries. There is limited literature addressing epilepsy in this condition, especially in Western countries.

This was a retrospective study conducted in the public hospitals of Aragón, analyzing data from all patients diagnosed with moyamoya angiopathy between 1981 and 2024. Epidemiological aspects of the disease were studied, as well as the presence of epilepsy and its management in this group of patients.

A total of 26 patients were included, with an estimated prevalence in Aragón of 1.71 cases per 100,000 inhabitants. The mean age at diagnosis was 36.64 years, with an equal sex distribution. Half of the patients presented with moyamoya syndrome. Fifty percent of the patients experienced a seizure and 42.31% of the total met diagnostic criteria for epilepsy. Most seizures were focal (81.8%), with a predominance of frontal lobe semiology. Levetiracetam was the most commonly used treatment. Up to four of the twelve patients with epilepsy met diagnostic criteria for drug-resistant epilepsy.

Although the prevalence of moyamoya in our series was lower than in Asian populations, the prevalence of epilepsy was significantly higher (50% of patients with seizures vs 0.9–18.9% in Asian series). In our cohort, epilepsy in moyamoya angiopathy was associated with the occurrence of syncope, cognitive impairment, affective disorders, and an earlier age at diagnosis. There are no other studies available addressing the percentage of drug-resistant epilepsy in these patients.