Lyme meningitis parkinsonism that mimics idiopathic Parkinson’s disease can be fully reversible with antibiotic treatment. A 79-year-old avid hunter developed two months of rapidly progressing weakness, persistent headache, shuffling gait, bradykinesia, tremor, and other parkinsonian symptoms initially attributed to degenerative neurologic disease. After diagnosis of Lyme meningitis based on CSF findings, positive serology, and tick exposure history, his symptoms resolved completely within four weeks of IV ceftriaxone — proving the parkinsonism was infection-driven, not permanent neurodegeneration.
When Parkinson’s Symptoms Aren’t Parkinson’s Disease
The case of a 79-year-old man whose symptoms were initially attributed to idiopathic Parkinson’s disease but later found to be due to Lyme meningitis was described by Patel and colleagues in “Atypical Lyme Meningitis with Parkinson Disease-Like Manifestations.” The man’s condition was “fully reversible” with intravenous ceftriaxone.
The Clinical Presentation
The patient, who had a history of follicular lymphoma in remission, experienced two months of rapidly progressing weakness and persistent headache, explains Patel. “He developed a shuffling, wide-based gait without rigidity, predominantly left-sided bradykinesia, marked intention tremor, postural tremor, hypomimia, hypophonia, and positive Romberg test.”
These symptoms — shuffling gait, bradykinesia (slowness of movement), tremor, hypomimia (reduced facial expression), hypophonia (soft speech) — are the cardinal features of Parkinson’s disease. In a 79-year-old man, the presumptive diagnosis would typically be idiopathic Parkinson’s disease requiring lifelong treatment with levodopa-carbidopa.
But the rapid progression over just two months, combined with persistent headache, should have raised suspicion for an atypical cause.
Diagnostic Workup
The authors ruled out cancer with a Computed tomography (CT) and CT angiogram of the head and paraneoplastic work-up. Lyme meningitis was diagnosed based upon:
- Cerebral spinal fluid analysis with 6 white blood cells per mm3 and 95% lymphocytes
- Positive Lyme serology (titer 2.57 LIV)
- History of exposure as an avid hunter
- Multiple tick bites after each outing
- Absence of another infection
The CSF findings — elevated lymphocytes — confirmed central nervous system inflammation. Combined with positive Lyme serology and extensive tick exposure history, the diagnosis was clear: neurologic Lyme disease causing meningitis with parkinsonian manifestations.
Complete Resolution With Antibiotics
Treatment was successful with Ceftazidime 1g IV every 8 hours for 2 days followed by a 4-week course of Ceftriaxone 2 g IV. “Within 4 weeks of therapy, his headache had resolved and he walked independently without difficulty.”
This is the critical finding: complete resolution of parkinsonian symptoms with antibiotics proves they were caused by active infection, not permanent neurodegeneration. He went from shuffling gait requiring assistance to walking independently. His tremor, bradykinesia, and other motor symptoms resolved.
If this had been idiopathic Parkinson’s disease, symptoms would have progressed despite treatment. Instead, treating the underlying infection cured the parkinsonism.
Understanding Parkinsonism vs Parkinson’s Disease
Parkinsonism is a group of heterogeneous degenerative neurological disorders, typically treated with levodopa-carbidopa. “Parkinsonism plus syndrome is a group of heterogeneous degenerative neurological disorders, which differ from the classical idiopathic Parkinson’s disease in certain associated clinical features, poor response to levodopa, distinctive pathological characteristics and poor prognosis,” according to Mitra.
There is a wide range of parkinsonian syndromes, which include idiopathic Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and vascular Parkinsonism (VaP), according to Litvan from the University of California.
This case demonstrates that infectious parkinsonism — caused by Lyme meningitis — should be added to the differential diagnosis, particularly in endemic areas with known tick exposure.
Clinical Perspective
This case highlights why rapid onset of parkinsonian symptoms — particularly with headache or other systemic symptoms — warrants investigation for infectious causes before assuming degenerative disease. The two-month progression was unusually fast for idiopathic Parkinson’s disease, which typically develops gradually over years.
The tick exposure history was critical. As an avid hunter with multiple tick bites, this patient had extensive exposure. Yet without considering Lyme disease as a cause of his neurologic symptoms, he might have been committed to lifelong Parkinson’s treatment for a curable infection.
The complete resolution with IV ceftriaxone is remarkable. Not improvement — resolution. He went from parkinsonian gait requiring assistance to walking independently within four weeks. This demonstrates the reversibility of infection-induced neurologic dysfunction when treated appropriately.
The Authors’ Conclusion
The authors conclude, “Lyme meningitis merits consideration in endemic areas in cases of subacute onset of Parkinsonism of unknown etiology, as it may be fully reversible with antibiotic therapy.”
Frequently Asked Questions
Can Lyme disease cause Parkinson’s-like symptoms?
Yes. Lyme meningitis can cause parkinsonism with shuffling gait, tremor, bradykinesia, and other motor symptoms mimicking Parkinson’s disease. Unlike degenerative Parkinson’s, Lyme-induced parkinsonism is reversible with antibiotics.
How did doctors know it was Lyme meningitis and not Parkinson’s disease?
CSF showed lymphocytic pleocytosis (elevated white blood cells), Lyme serology was positive, patient had extensive tick exposure, and symptoms resolved completely with IV antibiotics — proving infection, not neurodegeneration, was the cause.
Can parkinsonian symptoms from Lyme be reversed?
Yes. This patient’s symptoms were “fully reversible” with four weeks of IV ceftriaxone. He went from requiring assistance walking to walking independently, with complete resolution of tremor, bradykinesia, and other parkinsonian features.
Should Parkinson’s patients be tested for Lyme disease?
When parkinsonian symptoms develop rapidly (weeks to months rather than years), particularly with headache, fever, or known tick exposure, Lyme disease testing should be considered before assuming degenerative disease.
Related Reading:
Neurologic Lyme Disease: When Infection Affects the Brain
Brain Fog Lyme Disease: When Thinking Becomes Exhausting
Lyme Disease Fatigue: Why Rest Doesn’t Help
Chronic Neurologic Lyme Disease or Comorbidities?
References:
- Patel R, Larnard J, Poowanawittayakom N, Glew R. 1800: Atypical Lyme Meningitis with Parkinson Disease-Like Manifestations. Crit Care Med, 44(12 Suppl 1), 525 (2016).
- Mitra K, Gangopadhaya PK, Das SK. Parkinsonism plus syndrome–a review. Neurol India, 51(2), 183-188 (2003).
- Williams DR, Litvan I. Parkinsonian syndromes. Continuum (Minneap Minn), 19(5 Movement Disorders), 1189-1212 (2013).
Thank you for your work and research. A recent bioelectric scan has revealed both meningitis and borrelia, and tularemia just to name a few. However I have no way to receive treatment, no insurance, no MD, no funds. The irony is that I am a Physical Therapist Assistant without a job due to pain, weakness, fatigue, and brain fog.
The blog covers a case report from an abstract presented at a conference. We remain encouraged when physicians look a second time at a medical problems for an answer. In this case, treatment of a common medical problem, Lyme meningitis, resolved another common problem Parkinsonism.
I have Lyme meningitis could this be causing memory loss
Memory loss and poor concentration have been seen in individuals with Lyme disease.
About 4 years ago my mom got a tick bite on her back and within a few days a perfect bullseye about the size of a fist came up. She has never tested positive for lymes but she was treated a few times for it. During this same time she got to where she was unable to move to get out of bed. We finally took her to a neurologist and they diagnosed her with Parkinson’s. Within 30 minutes of taking the parkinson’s meds she was able to walk. I am still wondering if this was a coincidence or did it have something to do with the tick. My mom now cannot walk very good and her balance is bad, along with other issues. She was working 2 jobs moved around vibrant until she got the tick bite and since then she has went down hill. Just wondering your opinion.
Lyme disease, Parkinson’s disease, and Parkinsonism are common conditions. The case report reminds researchers to study whether there is a connection. I have had patient with both Lyme disease and Parkinsonism a the the same time. I had to work with a neurologist at the same time. You should gave have your mother evaluated in case any of her illness is related to a tick borne illness.
Dr Cameron. My mother was officially diagnosed with PSP about 12 months ago. She was treated for Lyme almost 20 years ago after years of testing to determine the cause of her fatigue. After intravenous treatment and months of oral antibiotics, she returned to full health. She is now in a memory care unit due to rapid on-set of PSP symptoms. She has fought for Lyme Treatment as she feels it is Lyme but her Doctors wont treat her for Lyme. I know that she may be grasping for an answer to a horrible diagnosis but why would a DR refuse to treat with Antibiotics?
It can be difficult to determine is two illnesses are connected (In this case Progressive supranuclear palsy (PSP) and a tick borne illness)).
They suspected my father has PSP as he has atypical Parkinsonisms. He also has some mild hydrocephalus on MRI. They plan to take some fluid from his spine to see if it improves his walking. Is there a specific test I should be asking them to run to test for this? He has untreated Lyme for several years in the 80’s and when it was discovered finally (he figured it out), he went on IV Cipro to cure it. He also lives in a tick area. Can it resurface? Normal blood Lyme tests were negative. Advice?
The spinal tap test for Lyme disease is not as reliable as I would like. For example, an increase in number of cells in the spinal fluid called pleocytosis can happen from many illnesses. I would not be surprised if you are referring to IV Rocephin rather than IV cipro.
I am sure I have Parkinsonism as I have Lyme, and the symptoms of Parkinsons seem to be rapidly progressing. Can you refer me to a nueologist in Chicago area that would be open to prescribing ceftriaxone. Thank you for this information and for your work.
I have seen both conditions in my practice in New York. I am glad someone is looking at the overlap. I am not familiar with the neurologists in your area.
Hi I would like to give my opinion. My mother back in 1985 was bitten by a tick, she had the bullseye rash. At the time we didn’t know about Lyme, so she had Lyme but was never diagnosed with it. I know she had it. Thinking back she had flu symptoms. Progressively got worse. She started falling backwards, we took her to a neurologist,who thought she may have psp We took her to Dr Golbe in New Brunswick. He diagnosed her with psp. Probably in 1990. She passed in 1993. No doubt in my mind it was from a tick.
Progressive supranuclear palsy (PSP)
Your case:
1.Cerebral spinal fluid analysis with 6 white blood cells per mm3 and 95% lymphocytes. 2. Positive Lyme serology (titer 2.57 LIV)
What if both are seronegative 10y after exposure to ticks??
Thank you for posting this
DR Cameron, my father had a stroke 4 years ago with inmediate onset of parkinsonism, after a cardiac episode where they did not prescribe anticoagulants. He had a tick byte before the cardiac episode, and he has never responded to levodopa. The parkinsonism continued to progress over the years. Last year he was tested against Lyme with a punction in the spine, and borrelia was confirmed, followed by 3 weeks ceftriaxona treatment. Not only it did not help, his parkinsonism progressed more rapidly after the antibiotic treatment, especially developing motor problems in the lower limbs, balance and gait problems, his tremor remains unchanged. He recently got a new treatment with neupro 6mg for 8 weeks, that we had to suspend as he got much worse, much quicker. Now he lies in the hospital due to this sudden worsening and has developed heart failure, he is being tested again on lyme, and a new MRI shows no differences with the one taken 4 years ago. Do you have any advise for us, as we are somehow desperate. Should we suspend levodopa treatment, as he never responded to levodopa? What if he is still positive to borrelia ? Is ceftriaxone enough or should we consider other antibiótics? Should we check a possible Lyme induced meningitis? Thanks in advance
I have patients with both conditions. I have faced the same challenges. I work along side the neurologist. I wish there were a tests to be sure a tick borne infection has resolved.