Can Lyme Disease Cause Stroke in Children? A Case

Lyme neuroborreliosis can rarely lead to stroke in children
Cerebral vasculitis may reduce blood flow and contribute to aneurysms
Earlier neurologic symptoms preceded the stroke in this case

Can Lyme disease cause stroke in children? Although rare, ischemic stroke has been reported in children with Lyme neuroborreliosis, particularly when cerebral vasculitis is present. This case describes a boy who developed headaches, seizures, hearing loss, cognitive difficulties, stroke, and multiple intracranial aneurysms.

Neurologic manifestations of Lyme disease occur in up to 15% of adults with Lyme disease, while the frequency among children may be higher, according to Kortela and colleagues from the University of Turku, the University of Helsinki, and Helsinki University Hospital in Finland.

Painful radiculopathy, facial nerve palsy, and lymphocytic meningitis are among the most common manifestations of neurologic Lyme disease. Epileptic seizures, cerebral vasculitis, stroke, and intracranial aneurysms are far less common but can present significant diagnostic challenges. These uncommon complications add to the broader spectrum of pediatric Lyme disease.

How Lyme disease can contribute to a stroke

Cerebral vasculitis, also called central nervous system vasculitis, is inflammation of blood vessel walls within the brain or spinal cord.

Inflammation involving cerebral arteries can narrow blood vessels, reduce blood flow, and increase the risk of an ischemic stroke. Damage to the vessel wall may also contribute to aneurysm formation.

Most patients with cerebral vasculitis experience headaches. Other symptoms may include cognitive impairment, gait disturbance, focal neurologic deficits, and stroke, according to Kortela.

In this child, Lyme neuroborreliosis-associated cerebral vasculitis was accompanied by an ischemic stroke and multiple intracranial aneurysms.

Early symptoms between ages 8 and 12

At age 8, the boy experienced recurrent attacks of severe headache and fever for several months. A brain magnetic resonance imaging (MRI) scan was reportedly normal, although the original records were unavailable for review.

The attacks resolved spontaneously. However, he continued to experience fatigue, mild motor clumsiness, and learning difficulties at school.

Three years later, he required hearing aids because of sensorineural hearing loss.

At age 12, he developed a seizure accompanied by hallucinations, vomiting, and aphasia.

Aphasia is a language disorder caused by injury to areas of the brain responsible for speaking, understanding language, reading, or writing.

Brain MRI demonstrated multiple abnormalities, including leptomeningeal, cranial nerve, and arterial wall enhancement consistent with an inflammatory process, along with disturbances in cerebrospinal fluid circulation.

“The changes were considered to be inflammatory, but it could not be judged whether they were acute or chronic,” the authors wrote.

An electroencephalogram demonstrated focal left-sided slow spike-wave discharges, and anticonvulsant therapy was started.

Seizures led to a Lyme neuroborreliosis diagnosis

During the following two months, the boy experienced three additional seizures. After his fourth seizure, he was readmitted to the hospital.

A spinal tap revealed lymphocytic meningitis. He was transferred to another hospital, where Lyme neuroborreliosis was diagnosed based on markedly abnormal cerebrospinal fluid findings.

The 12-year-old was treated with a two-week course of intravenous ceftriaxone. His anticonvulsant medication was later discontinued.

“After the antibiotic treatment, the auditory dysfunction normalized and the boy did not suffer from any epileptic seizures or attacks,” wrote Kortela. “However, the patient still had learning difficulties.”

Stroke symptoms developed at age 14

At age 14, the boy suddenly developed left hemiparesis and aphasia. Hemiparesis is weakness affecting one side of the body. His neurologic deficits resolved within several hours, consistent with a transient ischemic event.

An electroencephalogram was normal. However, cerebrospinal fluid testing again demonstrated low levels of Borrelia-specific IgM antibodies together with persistently elevated IgG antibodies.

The medical team initially decided not to retreat him with intravenous ceftriaxone for two reasons:

• The elevated IgG antibodies were considered consistent with previously treated Lyme neuroborreliosis.
• The cerebrospinal fluid CXCL13 concentration was relatively low at 58 pg/mL.

Brain MRI and magnetic resonance angiography (MRA) demonstrated an acute right temporal infarction. Imaging also identified an 8 mm partially thrombosed aneurysm of the left anterior cerebral artery along with two additional 2 mm aneurysms.

The boy was discharged on acetylsalicylic acid (aspirin) 200 mg daily with plans for surgical clipping of the largest aneurysm.

Multiple intracranial aneurysms were discovered

One week later, he returned to the hospital with an intense headache.

Computed tomography angiography and repeat magnetic resonance angiography showed no evidence of intracranial hemorrhage. However, three additional small aneurysms had developed.

“Craniotomy was performed immediately, because of the increased risk of aneurysm rupture and subarachnoid hemorrhage,” wrote Kortela. “The partially thrombotic aneurysm of the left anterior cerebral artery was surgically clipped.”

The medical team restarted treatment with a four-week course of intravenous ceftriaxone based on three findings:

1. Persistent fatigue
2. A marked increase in cerebrospinal fluid CXCL13 levels
3. Persistently elevated cerebrospinal fluid Borrelia burgdorferi-specific antibody levels

He also received five daily pulses of intravenous methylprednisolone (1 gram) in addition to acetylsalicylic acid.

What did the rising CXCL13 level mean?

After his stroke, the boy’s cerebrospinal fluid CXCL13 concentration increased substantially.

CXCL13 is a chemokine that attracts B cells and is often elevated early in Lyme neuroborreliosis, sometimes before intrathecal antibodies become detectable. Previous studies have shown that CXCL13 levels typically decline rapidly after successful antibiotic treatment.

The authors suggested that the renewed elevation in CXCL13 may have reflected ongoing inflammatory activity and discussed the possibility of reinfection. Because this report describes a single patient, however, the precise explanation for the biomarker increase cannot be determined with certainty.

The decision to retreat was based on the child’s overall clinical picture—including recurrent neurologic symptoms, cerebrospinal fluid findings, vascular imaging abnormalities, and rising inflammatory markers—rather than on the CXCL13 level alone.

Learning difficulties persisted after treatment

At age 16, the boy continued to experience learning difficulties despite improvement in his other neurologic symptoms.

Neuropsychological testing performed after surgery demonstrated overall moderate cognitive performance, with the greatest impairment involving verbal functions.

“Whether this was a consequence of neuroborreliosis or a chance association remains unknown,” the authors wrote.

This distinction is important. Although the case demonstrates an association between Lyme neuroborreliosis, cerebral vasculitis, stroke, and intracranial aneurysms, it cannot determine whether all of the boy’s long-term cognitive difficulties resulted directly from the infection.

Recent pediatric reports strengthen the association

When this case was first published, reports of pediatric stroke associated with Lyme neuroborreliosis were limited. Since then, additional case reports have reinforced the importance of considering Lyme disease in children with otherwise unexplained cerebrovascular events.

In 2025, Zakrzewski and colleagues described a 16-year-old who developed an ischemic stroke secondary to Lyme neuroborreliosis. The patient improved following intravenous ceftriaxone, highlighting that prompt recognition and treatment may improve neurologic outcomes.

A 2026 report by Pöyhönen and colleagues further expanded the evidence by describing two children with Lyme neuroborreliosis who developed cerebrovascular complications. One child experienced inflammatory narrowing of the posterior cerebral arteries without infarction, while the second developed an ischemic pontine stroke.

Both children were treated with intravenous ceftriaxone and improved clinically. The authors concluded that Lyme neuroborreliosis should be included in the differential diagnosis of pediatric stroke and cerebral vasculitis in children living in or traveling through Lyme-endemic regions.

Although these reports remain uncommon, they demonstrate that the present case is no longer an isolated observation. Together, the published literature suggests that Lyme neuroborreliosis can, in rare circumstances, involve inflammation of cerebral arteries severe enough to contribute to stroke.

Other reports of Lyme disease, vasculitis, and stroke

According to Kortela and colleagues, this was not the first report linking Lyme neuroborreliosis with cerebral vasculitis and intracranial aneurysms.

“We have previously published a case report of three LNB patients with cerebral vasculitis and intracranial aneurysms,” the authors noted. “However, cerebral vasculitis and/or stroke have been described in several patients with LNB.”

Mineyko and Kirton also reviewed inflammatory causes of childhood cerebral arteriopathy, noting that infectious diseases—including Lyme disease—can produce inflammation of cerebral arteries that may result in ischemic stroke.

Published reports have also described aneurysms involving the abdominal aorta, coronary arteries, and intracranial arteries in patients with Borrelia burgdorferi infection. These vascular complications remain rare, and individual case reports cannot prove a direct causal relationship.

Why the early symptoms mattered

The boy’s stroke did not occur in isolation. Years earlier, he had experienced recurrent headaches, fever, fatigue, mild motor clumsiness, hearing loss, learning difficulties, hallucinations, aphasia, and seizures.

Many of these symptoms can occur in conditions unrelated to Lyme disease. However, their progression over several years, together with inflammatory MRI findings and abnormal cerebrospinal fluid studies, ultimately supported the diagnosis of Lyme neuroborreliosis.

This case—and the more recent pediatric reports published in 2025 and 2026—illustrates why Lyme disease deserves consideration in the differential diagnosis when a child from a tick-endemic region presents with unexplained meningitis, cranial neuropathies, seizures, cerebral vasculitis, or ischemic stroke.

Although these complications are uncommon, recognizing Lyme neuroborreliosis early may allow timely antibiotic treatment before irreversible neurologic injury occurs. For a broader discussion of neurologic manifestations, see Lyme disease symptoms.

Frequently Asked Questions

Can Lyme disease cause stroke in children?

Yes, but it is rare. Lyme neuroborreliosis can cause inflammation of cerebral arteries (cerebral vasculitis), which may reduce blood flow and contribute to an ischemic stroke. Several pediatric case reports now support including Lyme disease in the differential diagnosis of unexplained childhood stroke in endemic areas.

What neurologic symptoms can Lyme disease cause in children?

Neurologic Lyme disease in children most commonly causes facial nerve palsy, meningitis, headaches, and cranial neuropathies. Less commonly, children may develop seizures, cerebral vasculitis, stroke, or cognitive changes.

Can Lyme disease be associated with brain aneurysms?

Yes, although it is very uncommon. Intracranial aneurysms have been reported in a small number of patients with Lyme neuroborreliosis and cerebral vasculitis. Individual case reports demonstrate an association but cannot prove that Lyme disease directly caused the aneurysms.

How is Lyme neuroborreliosis evaluated in a child with stroke?

Evaluation typically includes a neurologic examination, brain MRI, magnetic resonance angiography (MRA), cerebrospinal fluid analysis, and Lyme antibody testing. Physicians interpret these findings together with the child’s symptoms, imaging results, and potential tick exposure.

Why is early recognition important?

Early diagnosis may allow prompt antibiotic treatment before additional neurologic injury occurs. Although stroke remains a rare complication of Lyme neuroborreliosis, recent pediatric case reports highlight the importance of considering Lyme disease when the cause of cerebral vasculitis or stroke is unclear.

Clinical Takeaway

Stroke remains an uncommon complication of pediatric Lyme neuroborreliosis. However, this 2017 case is now supported by additional pediatric reports published in 2025 and 2026, strengthening the evidence that Lyme-associated cerebral vasculitis can occasionally lead to ischemic stroke.

Children with unexplained headaches, meningitis, cranial neuropathies, seizures, cerebral vasculitis, or stroke—particularly in Lyme-endemic regions—may warrant evaluation for Lyme neuroborreliosis as part of the differential diagnosis.

Early recognition and appropriate antibiotic treatment may improve neurologic outcomes and potentially prevent further vascular complications.

Related Articles

Learn more about neurologic Lyme disease and its diagnosis:

Pediatric Lyme disease
Lyme disease symptoms guide
Why Lyme disease tests can be negative early
Understanding Lyme disease test accuracy
What can happen when Lyme disease treatment is delayed
Recovery from Lyme disease

References

1. Kortela E, et al. Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis. JMM Case Reports. 2017;4(4):e005090.
2. Mineyko A, Kirton A. Mechanisms of pediatric cerebral arteriopathy: an inflammatory debate. Pediatr Neurol. 2013;48(1):14-23.
3. Oksi J, et al. Intracranial aneurysms in three patients with disseminated Lyme borreliosis: cause or chance association? J Neurol Neurosurg Psychiatry. 1998;64(5):636-642.
4. Hinterseher I, et al. Presence of Borrelia burgdorferi sensu lato antibodies in the serum of patients with abdominal aortic aneurysms. Eur J Clin Microbiol Infect Dis. 2012;31(5):781-789.
5. Cuisset T, Hamilos M, Vanderheyden M. Coronary aneurysm in Lyme disease: treatment by covered stent. Int J Cardiol. 2008;128(2):e72-e73.
6. Pöyhönen H, et al. Two pediatric Lyme neuroborreliosis patients presenting with cerebrovascular events. Ticks Tick Borne Dis. 2026.
7. Zakrzewski D, et al. Case report of ischemic stroke in a child secondary to neuroborreliosis. Neurol Sci. 2025.

---

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