Can Lyme Disease Cause Stroke in Children? A Lyme Neuroborreliosis Case
Rare neurologic complication in a child
Lyme neuroborreliosis with stroke and cerebral vasculitis
Recovery after diagnosis and treatment
Neurologic Lyme disease is reported in up to 15% of adults with Lyme disease and may be even more common in children. Although uncommon, Lyme neuroborreliosis has been associated with seizures, cerebral vasculitis, aneurysms, and ischemic stroke. This case report describes a child whose neurologic symptoms evolved over several years before Lyme disease was identified as the underlying cause.
“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 from the University of Turku, University of Helsinki, and Helsinki University Hospital in Finland.
Painful radiculopathy, facial nerve paresis, and lymphocytic meningitis are among the most common manifestations of neurologic Lyme disease. Epileptic seizures, cerebral vasculitis, ischemic stroke, and aneurysms are much less common.
Cerebral vasculitis, also referred to as central nervous system (CNS) vasculitis, is inflammation of blood vessel walls in the brain or spinal cord.
Most patients with cerebral vasculitis experience headaches. Other symptoms can include cognitive impairment, gait disturbances, focal neurologic deficits, and stroke. In this case, cerebral vasculitis associated with Lyme disease led to ischemic stroke and multiple aneurysms.
Ages 8 to 12
An 8-year-old boy experienced recurrent attacks of severe headache and fever over several months. Although an MRI was reportedly normal, the records were unavailable for review. The episodes resolved spontaneously, but the boy continued to struggle with fatigue, mild motor clumsiness, and learning difficulties in school.
Three years later, he required hearing aids because of sensorineural hearing loss.
At age 12, he experienced a seizure accompanied by hallucinations, vomiting, and aphasia. Brain MRI revealed leptomeningeal, cranial nerve, and arterial wall enhancement consistent with vasculitis, along with abnormalities in cerebrospinal fluid circulation.
Aphasia is a language disorder caused by damage to brain regions involved in communication and can affect speaking, reading, writing, and comprehension.
The findings were considered inflammatory, although it was unclear whether they represented an acute or chronic process. Electroencephalography (EEG) demonstrated focal left-sided slow spike-wave discharges, and anticonvulsant therapy was started.
Over the next two months, the boy experienced three additional seizures. Following a fourth seizure, a spinal tap revealed lymphocytic meningitis.
He was transferred to another hospital, where Lyme disease was diagnosed based on clearly abnormal cerebrospinal fluid findings. The child was treated with two weeks of intravenous ceftriaxone, and anticonvulsant medication was discontinued.
“After the antibiotic treatment, the auditory dysfunction normalized and the boy did not suffer from any epileptic seizures or attacks,” wrote Kortela and colleagues. However, learning difficulties persisted.
Can Lyme Disease Cause Stroke in Children?
At age 14, the boy developed transient left-sided weakness and aphasia that resolved within hours. Although the EEG was normal, cerebrospinal fluid testing showed persistent elevation of Borrelia-specific IgG antibodies.
Intravenous ceftriaxone was initially withheld because the elevated antibodies were thought to reflect previously treated Lyme disease and because cerebrospinal fluid CXCL13 levels were low.
Brain MRI and magnetic resonance angiography subsequently demonstrated an acute right temporal infarct, confirming an ischemic stroke. Imaging also identified an 8 mm aneurysm with partial thrombosis in the left anterior cerebral artery, along with two smaller aneurysms.
The boy was discharged on acetylsalicylic acid with plans for surgical clipping.
Lyme disease has previously been associated with aneurysm formation in rare reports.
One week later, he returned to the hospital with severe headache. Additional imaging revealed three more aneurysms.
“Craniotomy was performed immediately because of the increased risk of aneurysm rupture and subarachnoid hemorrhage,” wrote the authors. The partially thrombosed aneurysm was surgically clipped.
The boy was then treated with four weeks of intravenous ceftriaxone based on persistent fatigue, elevated CXCL13 levels, and ongoing intrathecal antibody production. He also received five pulses of intravenous methylprednisolone and acetylsalicylic acid.
The level of CXCL13 increased despite prior treatment. According to the authors, elevated CXCL13 has been reported in early Lyme neuroborreliosis and often falls rapidly following antibiotic therapy.
Outcome at Age 16
At age 16, the boy remained free of seizures but continued to experience learning difficulties.
A neuropsychological evaluation demonstrated moderate cognitive impairment, particularly involving verbal functions. Whether these deficits resulted directly from Lyme neuroborreliosis or represented a coincidental finding could not be determined.
The patient’s neurologic symptoms evolved over several years before Lyme neuroborreliosis was identified, illustrating how challenging the diagnosis can be in some children.
According to the authors, this was not the first report linking Lyme neuroborreliosis to cerebral vasculitis and intracranial aneurysms in children. Previous reports have described both aneurysms and ischemic stroke associated with Lyme neuroborreliosis.
Frequently Asked Questions
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.
What is Lyme neuroborreliosis?
Lyme neuroborreliosis occurs when Lyme disease affects the nervous system. Symptoms can include meningitis, facial palsy, nerve pain, cognitive problems, seizures, and, rarely, stroke.
Can Lyme disease cause seizures?
Seizures are an uncommon manifestation of Lyme neuroborreliosis but have been described in pediatric and adult cases.
Can Lyme disease cause cerebral vasculitis?
Rare reports have linked Lyme neuroborreliosis to cerebral vasculitis, which can affect blood flow within the brain and contribute to neurologic complications.
Can Lyme disease cause learning difficulties in children?
Cognitive and learning difficulties have been reported in some children with neurologic Lyme disease, although symptoms and long-term outcomes vary.
Clinical Takeaway
This case highlights a rare but serious manifestation of pediatric Lyme neuroborreliosis involving seizures, cerebral vasculitis, ischemic stroke, and multiple intracranial aneurysms.
Early symptoms such as headaches, fatigue, learning difficulties, hearing changes, meningitis, or seizures may precede more serious neurologic complications, highlighting the importance of considering Lyme neuroborreliosis in children from endemic regions.
Although uncommon, Lyme neuroborreliosis should remain part of the differential diagnosis when children present with unexplained neurologic symptoms, stroke, or evidence of cerebral vasculitis.
Related Articles
Neurologic Lyme disease
Pediatric Lyme disease
Can Lyme disease cause a stroke?
Brain fog and Lyme disease
References
- Kortela E, et al. Cerebral vasculitis and intracranial multiple aneurysms in a child with Lyme neuroborreliosis. JMM Case Rep. 2017;4(4):e005090.
- 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.
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
