Stroke-Like Symptoms? Babesiosis Can Mimic a TIA
Babesiosis can cause confusion, slurred speech, and ataxia—symptoms that may mimic a stroke or transient ischemic attack (TIA).
When neurologic symptoms occur alongside fever or flu-like illness, clinicians should consider infection—not just a vascular event.
Sudden confusion. Slurred speech. Trouble walking.
In some cases, these symptoms may not be caused by a blocked blood vessel, but by a tick-borne infection such as babesiosis.
Individuals with babesiosis can experience fevers, chills, myalgias, anorexia, headache, nausea, and vomiting. According to the authors, “The least common are shortness of breath, sore throat, neck stiffness, emotional lability, photophobia, and dark urine.”
Learn more about babesiosis.
Why Babesiosis Can Look Like a Stroke
Babesiosis is typically known for causing fever, chills, and hemolytic anemia.
However, in some patients—especially older adults—it can present primarily with neurologic symptoms.
These may include:
- Confusion or cognitive impairment
- Slurred speech
- Ataxia (loss of coordination)
- Difficulty concentrating
This symptom pattern can closely resemble a transient ischemic attack (TIA) or stroke.
In their study entitled “Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations,” the authors summarize two cases that presented with stroke-like or TIA-like neurologic symptoms.
Two Cases of Babesiosis With Neurologic Symptoms
Both patients were in their 70s with multiple co-morbidities.
They were admitted to the hospital “with similar symptoms of confusion/cognitive impairment, slurred speech, ataxia, fever, myalgias and chills, urinary frequency, and urgency,” the authors wrote.
Neither patient recalled a tick bite or recent travel outside the country.
The first patient was treated successfully for babesiosis, Anaplasma, and Lyme disease with a combination of atovaquone, azithromycin, and doxycycline for 10 days.
The second patient was initially treated for suspected sepsis with broad-spectrum antibiotics, intravenous fluids, pressor support, and blood transfusion.
He was later treated successfully for babesiosis, Lyme disease, and Mycoplasma pneumoniae using atovaquone, azithromycin, and doxycycline.
Both patients recovered after the correct diagnosis and treatment.
Why the Diagnosis Is Often Missed
Neurologic symptoms in tick-borne illness are often attributed to Lyme disease or anaplasmosis.
Babesiosis is usually viewed primarily as a blood infection rather than a neurologic illness.
This creates a diagnostic blind spot.
According to the authors, there are relatively few reports describing neurologic manifestations of babesiosis involving cognitive or motor dysfunction.
Published neurologic cases have more commonly been attributed to Lyme disease or anaplasmosis rather than babesiosis itself.
When to Suspect Infection Instead of Stroke
Stroke typically presents without systemic infectious symptoms.
Babesiosis may be more likely when neurologic symptoms occur alongside:
- Fever or chills
- Muscle aches
- Fatigue
- Anemia or abnormal blood counts
- Hemolysis
This combination should raise suspicion for a tick-borne infection affecting the nervous system.
See also Lyme disease misdiagnosis.
The Role of Co-Infections
Both patients had multiple infections, including babesiosis and Lyme disease.
Co-infections may worsen symptoms and complicate diagnosis.
Neurologic symptoms may reflect overlapping inflammatory, infectious, and vascular mechanisms.
Why Testing Can Be Negative
Babesiosis is commonly diagnosed using blood smear, PCR testing, or serology.
However, testing may be negative in patients with low parasitemia.
Clinical judgment remains essential when suspicion is high.
Editor’s note: These cases were well documented. It is more difficult to publish neurologic babesiosis cases when parasites are not identified on blood smear and laboratory testing is negative.
Frequently Asked Questions
Can babesiosis cause stroke-like symptoms?
Yes. Babesiosis can occasionally cause confusion, slurred speech, cognitive impairment, and ataxia that mimic stroke or TIA symptoms.
What neurologic symptoms can occur with babesiosis?
Reported neurologic symptoms include confusion, impaired concentration, slurred speech, ataxia, and cognitive dysfunction.
Why is babesiosis sometimes mistaken for stroke?
Older adults with babesiosis may present with sudden neurologic symptoms, making stroke or TIA a common initial concern.
Can babesiosis occur without a known tick bite?
Yes. Many patients with babesiosis do not recall a tick bite.
Can patients recover from neurologic babesiosis?
Yes. Prompt recognition and treatment may lead to significant improvement or complete recovery.
Clinical Takeaway
Babesiosis can mimic stroke-like neurologic symptoms but may improve significantly with prompt treatment.
When confusion, slurred speech, or ataxia occur alongside fever or systemic symptoms, clinicians should consider tick-borne infection in the differential diagnosis.
Increasing recognition of neurologic babesiosis may help reduce delayed diagnosis and improve outcomes.
Related Articles
Lyme Disease Symptoms Guide
Babesia Testing and Diagnosis
Post-Treatment Lyme Disease Syndrome
Autonomic Dysfunction and Lyme Disease
References
- Venigalla T, Adekayode C, Doreswamy S, Al-Sudani H, Sekhar S. Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations. Cureus. 2022;14(7):e26811.
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
The case reports are very important since babesia and the neurological manifestations are so hard to validate and recognize in the clinical setting. Excellent work! would be further validated if they made a longer follow up. I am curious to know if the treatment was long lasting. Is babesia a relapsing illness? The symptom characteristics I am familiar with include a dull long lasting headache and what patients refer to as “ air hunger”. Would the dark urine be related to porphyria ? Has anyone investigated the cause of the dark urine?
It would be interesting to know better how babesia impacts the neurological system and why. Many thanks. ABK
I often find that Babesia helps early on but has to be treated longer to resolve the infection.
After a full 2 year regimen of atovaquone, proguanil, azithromycin, along with negative diagnostic tests for the organism Babesia, and a full year of these negative test results, I was taken off these medicines. During the 2 year period, my blood values were mostly suboptimal. Very gradually, my blood values improved with the exception of my high bilirubin (6.0), very low haptoglobin, and platelets (100k). A couple weeks ago, I went off the meds I was taking for the Babesia. After a 2 week wait, I had blood work done. All of these 3 values improved greatly! Bilirubin halved, haptoglobin approaching normality, BUT platelets remained at 100k. I can’t figure out these platelets. Urine has shown much less reddish tint, also. I’m guessing the atova was the culprit, but I could be wrong. What say you?
thanks so much
Oops! I said platelets were considerably improved but that was incorrect. They’ve been pretty much the same during the med regimen, low. The lowest they got was 22k, the highest before the recent blood test was 128k. I will be submitting to another round of blood work within 2 weeks and I’ll see how things are going.
Good morning,
I was diagnosed with Babesia in 2007. Doctors treated the Lyme with Docycycline twice. No treatment for the Babesia.
I am really curious to know if others go through drenching sweats and chills at the same time. It continues daily it’s embarrassing and ruins my clothing.
I hope someone can enlighten me.
Thank you
Sydney- I also have what you described. I have tried to explain it to many drs. They just dont seem to understand what I mean. It feels like the inside of my body is boiling. I can touch my skin and know that it is cool to the touch, but I can not feel the cold. I just dont say this well- When in a flare- I am so hot and sweaty that I can hardly stand it- I go outside in winter in short sleeves to cool off. I have been told that my autonomic nervous system is damaged from the long term Lyme and Babesia and I believe that is where this comes from. When treatment works- it goes away. So I know it “isn’t all in my head”. Thanks
Jan,
Hi. Thanks for your response. How about your legs and arms looking mottled?
Told my psychiatrist once, she said dead people have mottled skin and moved on
Some of my patients have recurring blue hands and feet from autonomic problems related to a tick borne illness
Is there any evidence for kidney damage (CKD) caused by Babesiosis?
I have not seen CKD due to Lyme disease in my practice.
Do any patients with Lyme/Babesia have to deal with
Ear and nose cartilage becoming very pain to the touch?
Mine is not everyday, it just pops up out of the blue.
Sydney
I have not asked my patients about their ear and nose cartilage. I have patients whose skin is very painful or burning from a tick borne illness. Their symptoms typically clear if there tick borne infection is treated
Lyme can cause deterioration of cartilage I’ve read because it hungry for collagen. There’s a fb group that a guy started because he started having serious problems with rib slippage as a result of Lyme
This happens to me! I will wake up with an ear that hurts so bad. But the outside part, not like an ear infection.
I am currently being treated for Lyme/Babesia/ Mycoplasma pneumoniae. Have you heard of utilizing bacteriaphages for treatment? I’m in the process and am already seeing some changes for the better. My migraines have been reduced as well as my brain fog. I originally went on antibiotics for 2 years with no luck. Just wanted to pass this on for others.
I suffered from acute, sudden onset feelings of nausea and anxiety (terror really) that lasted for only a minute or two, but followed with confusion, lesser anxiety, brain fog and memory issues. This continued for 2-3 days with attacks recurring every hour for the first day and then lessening in intensity and frequency. There was 6 months between the first episode and the second, but only 2 months between the second and third. My regular physician was baffled and suggested therapy for the anxiety.
Because my wife suffers with long Lyme disease, she suggested that I see her specialist and get the iGeneX blood tests. I did this and was positive for Babesia and put on a four week course of Atovaquone and Azithromicyn. So far, I have had no more “attacks” and my mental clarity and anxiety are much improved.
Further, I am going to be consulting with a Neurologist to determine if anything else is needed.
I am glad you improved. It is reasonable to consult a neurologist given your symptoms were so severe