Lyme Meningitis Presenting as Parkinsonism: A Reversible Cause
Parkinsonian symptoms are typically associated with neurodegenerative disease. However, in some cases, infection may present with similar features. A reported case highlights Lyme meningitis presenting with parkinsonism that improved following antibiotic treatment. :contentReference[oaicite:0]{index=0}
When Parkinson’s Symptoms Have Another Cause
A 79-year-old man developed two months of progressive weakness, persistent headache, and changes in gait and movement. His symptoms—including tremor, bradykinesia, and reduced facial expression—were initially consistent with Parkinson’s disease.
However, the relatively rapid progression and associated headache raised concern for an alternative explanation.
The Clinical Presentation
The patient, an avid hunter with frequent tick exposure, presented with:
- Shuffling, wide-based gait
- Bradykinesia (slowed movement)
- Tremor (intention and postural)
- Hypomimia (reduced facial expression)
- Hypophonia (soft speech)
- Positive Romberg test
These findings closely resemble idiopathic Parkinson’s disease but developed over a shorter timeframe than typically expected.
Diagnostic Workup
Further evaluation revealed findings consistent with Lyme meningitis:
- Cerebrospinal fluid with lymphocytic predominance
- Positive Lyme serology
- History of repeated tick exposure
- No alternative infectious or malignant explanation
The diagnosis of neurologic Lyme disease was made based on the combination of clinical, laboratory, and exposure history.
Response to Treatment
The patient was treated with intravenous antibiotics, followed by a four-week course of ceftriaxone.
Over the course of treatment, his headache resolved and his mobility improved. He regained the ability to walk independently.
This clinical improvement suggests that the parkinsonian features were related to infection rather than a primary neurodegenerative process.
Parkinsonism vs Parkinson’s Disease
Parkinsonism describes a group of movement disorders characterized by tremor, rigidity, and slowed movement.
While idiopathic Parkinson’s disease is the most common cause, secondary forms—including those related to infection—should be considered in selected cases.
This case highlights the importance of including infectious etiologies, such as Lyme disease, in the differential diagnosis—particularly in patients with subacute onset and relevant exposure history.
Clinical Perspective
Rapid onset of parkinsonian symptoms over weeks to months, especially when accompanied by headache or systemic symptoms, may warrant evaluation for infectious causes.
Exposure history remains an important clue. In endemic regions, tick exposure may help guide further diagnostic consideration.
While not all cases of parkinsonism are reversible, this case illustrates that identifying an underlying infection can alter management and clinical trajectory.
Frequently Asked Questions
Can Lyme disease cause Parkinson-like symptoms?
Yes. Lyme meningitis may present with parkinsonian features such as tremor, slowed movement, and gait changes.
How can Lyme-related parkinsonism be distinguished?
Clues may include rapid onset, associated symptoms such as headache, abnormal cerebrospinal fluid findings, and a history of tick exposure.
Can these symptoms improve with treatment?
In some cases, symptoms may improve following appropriate antibiotic therapy, particularly when infection is identified early.
When should Lyme disease be considered?
Lyme disease may be considered in patients with subacute neurologic symptoms and potential tick exposure, especially in endemic areas.
Related Reading:
Neurologic Lyme Disease
Brain Fog Lyme Disease
Lyme Disease Fatigue
Chronic Neurologic Lyme Disease or Comorbidities?
References:
- Patel R et al. Atypical Lyme Meningitis with Parkinson Disease-Like Manifestations. Crit Care Med. 2016.
- Mitra K et al. Parkinsonism plus syndrome. Neurol India. 2003.
- Williams DR, Litvan I. Parkinsonian syndromes. Continuum. 2013.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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.