Lyme Neuroborreliosis in Children: A Case of Stroke and Aneurysms
Lyme neuroborreliosis in children can present with a wide range of neurologic symptoms—some of which are uncommon and easily missed.
Neurologic Lyme Disease in Children
Lyme neuroborreliosis in children may present with meningitis, facial nerve palsy, radiculopathy, and less commonly seizures, stroke, or aneurysms.
The CDC describes neurologic Lyme disease as including meningitis, facial palsy, and nerve-related pain.
“Neurological manifestations are reported in up to 15% of adult patients with Lyme disease, while the frequency among children is higher,” write Kortela and colleagues.
For more on pediatric presentations, see pediatric Lyme disease diagnostic challenges. A broader overview is available in the Lyme disease symptoms guide.
Common neurologic findings include painful radiculopathy, facial nerve palsy, and lymphocytic meningitis. More severe complications—such as cerebral vasculitis, stroke, and aneurysms—are rare but reported.
Case Presentation: Ages 8 to 12
An 8-year-old boy presented with recurrent episodes of severe headache and fever over several months. Although early imaging was reportedly normal, he later developed fatigue, mild motor clumsiness, and learning difficulties.
By age 12, the patient experienced a seizure accompanied by hallucinations, vomiting, and aphasia.
Brain MRI revealed leptomeningeal, cranial nerve, and arterial wall enhancement consistent with vasculitis, along with disturbances in cerebrospinal fluid circulation.
A spinal tap demonstrated lymphocytic meningitis, and Lyme disease was confirmed based on cerebrospinal fluid findings.
The patient was treated with intravenous ceftriaxone for 2 weeks. Following treatment, seizures resolved and auditory dysfunction improved, though learning difficulties persisted.
Progression: Ages 14 to 16
At age 14, the patient developed transient left-sided weakness and aphasia. Imaging revealed an acute infarct and multiple intracranial aneurysms.
Initial findings were attributed to prior infection, and treatment was deferred. However, worsening symptoms—including severe headache and additional aneurysm formation—prompted further intervention.
A craniotomy was performed to clip a partially thrombosed aneurysm due to the risk of rupture.
The patient was then treated with a 4-week course of intravenous ceftriaxone based on persistent symptoms, elevated CXCL13 levels, and continued evidence of Borrelia-specific antibodies in cerebrospinal fluid.
CXCL13 is a chemokine associated with early Lyme neuroborreliosis and may rise before antibodies are detectable. Levels typically decline after treatment.
At age 16, the patient remained free of seizures but continued to have some cognitive and learning difficulties.
Clinical Implications
This case illustrates that Lyme neuroborreliosis in children may occasionally lead to serious complications such as cerebral vasculitis, stroke, and aneurysm formation.
Infectious triggers—including Borrelia burgdorferi—may contribute to inflammatory changes in cerebral arteries.
Lyme disease has also been associated with aneurysms in intracranial, coronary, and aortic vessels.
Why This Case Matters
This report highlights the importance of including Lyme disease in the differential diagnosis of neurologic symptoms in children, particularly in endemic areas.
Early recognition and treatment may reduce the risk of severe complications, although outcomes can still vary.
Clinical Takeaway
Lyme neuroborreliosis is more common in children than adults and can rarely present with serious neurologic complications, including stroke and aneurysms. Careful evaluation and early treatment are important in at-risk patients.
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
