Can Lyme Disease Cause a Stroke?
Lyme neuroborreliosis has been linked to rare stroke cases.
Neurologic symptoms may mimic other serious conditions.
Stroke-like symptoms may warrant further evaluation.
The study entitled “Ischemic Stroke With Hemorrhagic Conversion in a Case of Lyme Neuroborreliosis” by Sathi and colleagues describes the case of a 59-year-old man who presented to a hospital in Florida with ischemic stroke, aphasia, and acute confusion that had been ongoing for two days.
The patient’s medical history included atrial fibrillation on apixaban, coronary artery disease, hypertension, and type 2 diabetes mellitus.
He lived in Michigan and reportedly had developed a rash 10 years earlier that resolved without medical evaluation.
Lyme Neuroborreliosis and Stroke
“This would be the sixth reported case in the US of Lyme neuroborreliosis concurrent with ischemic stroke where LNB may be determined to be causal.”
According to the authors, Lyme disease was suspected because of the patient’s travel from an endemic area, clinical history, and MRI findings showing multiple abnormal white matter lesions.
A spinal tap was positive for Borrelia burgdorferi IgM and IgG antibodies as well as varicella-zoster virus (VZV) IgG.
Additional imaging demonstrated ischemic stroke with hemorrhagic conversion.
READ MORE: Lyme disease triggers stroke in an 83-year-old man, leaving him partially paralyzed.
Treatment and Recovery
The patient was treated with IV ceftriaxone for 30 days.
“As the hospital course progressed, the patient began to improve in his receptive aphasia and encephalopathy,” the authors wrote.
By day 14, repeat CT imaging showed no progression of the hemorrhagic conversion.
The patient became alert, oriented, and able to follow commands.
Follow-up imaging reportedly demonstrated improvement in the white matter abnormalities, although some receptive and expressive aphasia persisted.
According to the authors, the patient was ultimately able to resume work and normal daily activities.
How Can Lyme Disease Affect the Brain?
Lyme neuroborreliosis can affect the central nervous system and may present with:
- Confusion
- Aphasia
- Ataxia
- Meningitis
- Radiculopathy
- Cognitive dysfunction
- Stroke-like symptoms
Rarely, inflammation involving cerebral blood vessels may contribute to ischemic stroke complications in Lyme neuroborreliosis.
Clinical Perspective
Most strokes are not caused by Lyme disease.
However, this case highlights that Lyme neuroborreliosis may occasionally appear in the differential diagnosis of patients presenting with acute neurologic symptoms, particularly in endemic regions or in patients with compatible clinical histories.
“Neuroborreliosis should be considered in the differential in patients who present with stroke or acute confusional state in endemic areas of Lyme disease.”
FAQ: Lyme Disease and Stroke
Can Lyme disease cause a stroke?
Rarely, Lyme neuroborreliosis has been associated with ischemic stroke and stroke-like neurologic complications.
What is Lyme neuroborreliosis?
Lyme neuroborreliosis refers to nervous system involvement caused by Lyme disease.
What symptoms can occur with neurologic Lyme disease?
Symptoms may include confusion, meningitis, facial palsy, cognitive dysfunction, radicular pain, or stroke-like neurologic deficits.
Related Articles:
Untreated Lyme disease triggers a stroke in a 9-year-old boy
References:
- Sathi S, Kim D, Duplan P, Kim P, Shenkamn C. Ischemic Stroke With Hemorrhagic Conversion in a Case of Lyme Neuroborreliosis. Cureus. 2022;14(8):e28028. doi:10.7759/cureus.28028
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
I had a stroke from Lyme as well; but highly doubt it was ever recorded as such? Don’t even know where to start to get that info to the right people?
I was pleased that there are a few cases reports that have been published. I hope my blog encourages further work on this subject.
Me too Dr Cameron.
I had a a “supposed” stoke in 2015. I was getting progressively ill since 2007 and had suggested to my family doctor the possibility offli lyme disease ( I removed an engorged tick and had red circle rash on my outer calf). He dismissed it. I had facial palsy from 2011 to 2017, but no treatment. In 2015 presented at the ER with progressive numbness in the foot and hand. Over the course of 24 hours I went completely numb on the right side. It was stated I had a white matter lesion on my thalamus and that I had experienced a posterior arterial blockage resulting in an infarct. To this day I am not sure if it was a stroke or a lesion from the Lyme infection. The neurologist said it was an ischemic stroke, but Lyme disease was never considered at first and when I mentioned it to my neurologist, he said, “he was not convinced” and that we all have Lyme disease in our system don’t we through exposure. Also, he said, the ND treating me for Lyme disease was ripping me off. Needless to say. I got rid of him.
Thanks for sharing. BTW white spots are common in a number of conditions besides stroke and Lyme disease. Some people can have Lyme disease and a stroke. The neurologist cannot do much about the stroke. I have had patients who have had both conditions.
Dr Cameron thank you for your reply. Can a Lyme lesion appear as an infarct on an MRI or be confused to be an ischemic stroke. What is the difference in representation on the MRI?