Neurologic Lyme Disease Misdiagnosed as Conversion Disorder
Neurologic Lyme disease may mimic Guillain-Barré syndrome
Weakness, falls, and hyporeflexia may complicate diagnosis
Conversion disorder may initially be suspected
Teodoro and colleagues describe the case of a woman who was initially suspected of having a conversion disorder but later diagnosed with Guillain-Barré syndrome, possibly triggered by neurologic Lyme disease.¹
Conversion disorder is a mental condition in which a person develops blindness, paralysis, or other neurologic symptoms that cannot be explained by routine medical evaluation.
The woman presented to the emergency room with weakness in her left hand and both legs, resulting in two consecutive falls with head trauma. Initial testing was reportedly normal, and she was discharged.
But the following day her symptoms worsened, and she returned to the hospital unable to walk independently and experiencing urinary incontinence.
“On admission, her neurological examination revealed asymmetric tetraparesis, hyporeflexia, doubtful hemihypesthesia, and left extensor plantar reflex,” wrote Teodoro and colleagues in Case Reports in Neurology.¹
Tetraparesis refers to weakness involving all four extremities. Hemihypesthesia refers to reduced sensation on one side of the body.
Why Conversion Disorder Was Initially Considered
The patient was initially treated for a conversion disorder because her symptoms appeared inconsistent and fluctuating.
The authors noted findings that supported this interpretation, including a positive Hoover sign during one examination, fluctuating weakness, recent stressful life events, and significant anxiety.¹
The patient was prescribed sertraline and pregabalin.
However, by hospital day five her condition had worsened substantially.
Her limbs became areflexic, and electromyography (EMG) revealed “a subacute motor axonal neuropathy pattern and a right median nerve mononeuropathy.”¹
Guillain-Barré Syndrome Considered
Guillain-Barré syndrome was then considered based on EMG findings and spinal fluid analysis showing albuminocytologic dissociation — a hallmark feature of Guillain-Barré syndrome.¹
The patient was treated with a 5-day course of intravenous immunoglobulin (IVIG), which led to partial neurologic improvement.
Cases of Guillain-Barré syndrome have previously been misdiagnosed as conversion disorder, highlighting the diagnostic complexity of atypical neurologic presentations.²
Neurologic Lyme Disease Diagnosis
The woman was subsequently diagnosed with neurologic Lyme disease after testing revealed positive Lyme IgM antibodies and inflammatory findings in the cerebrospinal fluid.¹
“None of the most common infectious agents associated with Guillain-Barré syndrome were identified. Surprisingly, serologies for Borrelia were revealed to be positive, with further finding of IgM Borrelia antibodies in CSF,” the authors explained.¹
The authors emphasized that Lyme neuroborreliosis can occasionally mimic Guillain-Barré syndrome.³
The patient was treated with a 14-day course of ceftriaxone and experienced significant improvement in motor function, although she still required rehabilitation therapy at discharge.¹
Learn more about neurologic Lyme disease.
Neurologic Lyme Disease Can Mimic Other Disorders
Neurologic Lyme disease may occasionally resemble autoimmune, psychiatric, or functional neurologic disorders.
Weakness, sensory changes, falls, gait instability, urinary symptoms, hyporeflexia, and cognitive dysfunction may create diagnostic uncertainty — especially when early imaging or laboratory testing appears unrevealing.
Delayed diagnosis may postpone appropriate antimicrobial therapy and rehabilitation.
Learn more about Lyme disease misdiagnosis.
Frequently Asked Questions
Can Lyme disease mimic Guillain-Barré syndrome?
Yes. Rare cases of neurologic Lyme disease have resembled Guillain-Barré syndrome with weakness, hyporeflexia, sensory symptoms, and abnormal spinal fluid findings.
What is conversion disorder?
Conversion disorder is a condition in which neurologic symptoms occur without a fully explained structural neurologic cause.
Can neurologic Lyme disease cause weakness and falls?
Yes. Neurologic Lyme disease may lead to weakness, gait instability, falls, sensory changes, and impaired reflexes in some patients.
What is hyporeflexia?
Hyporeflexia refers to reduced reflex responses during neurologic examination and may occur in peripheral nerve disorders including Guillain-Barré syndrome.
How is neurologic Lyme disease diagnosed?
Diagnosis may involve clinical evaluation, Lyme antibody testing, cerebrospinal fluid analysis, and neurologic studies such as EMG.
Clinical Takeaway
Neurologic Lyme disease may occasionally mimic Guillain-Barré syndrome or functional neurologic disorders, creating substantial diagnostic uncertainty.
Weakness, falls, urinary symptoms, sensory abnormalities, hyporeflexia, and fluctuating neurologic findings may initially be attributed to psychiatric or autoimmune conditions.
A careful differential diagnosis remains essential when evaluating atypical neurologic presentations in patients at risk for Lyme disease.
Related Articles
These related articles explore autoimmune overlap, delayed diagnosis, coinfections, and neurologic complications associated with Lyme disease.
Lyme disease symptoms guide
Lyme disease coinfections
Can Lyme disease trigger an autoimmune disease?
Lyme disease mimics autoimmune disorder in elderly woman
Delayed Lyme disease diagnosis
- Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019;11(1):142-147.
- Edelsohn G. Guillain-Barré misdiagnosed as conversion disorder. Hosp Community Psychiatry. 1982;33(9):766-767.
- Tyagi N, Maheswaran T, Wimalaratna S. Neuroborreliosis: the Guillain-Barré mimicker. BMJ Case Rep. 2015.
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
Very similar story to my then 16 yo daughter. But we were not given any other diagnosis or testing beyond conversion disorder. I was told repeatedly that we were too ‘enmeshed’ and that I was contributing to her CD. So very sad. She’s 26 now and I know would have been on the road to healing had we been not sent down the wrong path repeatedly for so many years.
Listen to your gut and get another and another opinion if needed! Hard lesson to learn for us, I pray other don’t have to.
I have had Lyme patients who have gone down the conversion disorder path before being diagnosed. I was happy that the authors described case.
Hi my name is Kristen I had bullseye rash on skin 16 years ago. Got very sick after. Western Blot negative over and over. Had no idea about confections back then. Was hospitalized and diagnosed with trygiminal neuralgia. Suffering for years endless surgeries and radiation. Spinal tap negative. Epstein Barr showing up often.. Thousands dollars spent on treatment only to come up negative. I have severe flair ups. Excited to join this group.
I find the tests for Lyme disease and co-infections are not all that good. Welcome to the group.