Conversion Disorder, Guillain-Barré Syndrome, or Neurologic Lyme Disease?
Symptoms worsened despite treatment
Neurologic findings did not fit
Psychiatric diagnosis came first
Infection was identified later
Neurologic Lyme disease can mimic psychiatric and neurologic conditions, leading to delayed diagnosis when symptoms are attributed to non-infectious causes.
Neurologic symptoms that worsen despite psychiatric treatment rarely prompt infectious disease testing—even when a patient presents with progressive paralysis and urinary incontinence.
Neurologic Lyme disease can mimic several conditions—including autoimmune disorders, psychiatric illness, and peripheral neuropathies—making diagnosis particularly challenging in atypical cases.
For a broader discussion, see Lyme disease misdiagnosis.
Initial Presentation and Early Dismissal
A 62-year-old woman presented with weakness in her left hand and both legs, resulting in falls with head trauma. Initial testing was normal, and she was discharged.
The following day, symptoms worsened. She returned with inability to walk independently and urinary incontinence.
Neurologic examination revealed asymmetric tetraparesis, hyporeflexia, and sensory abnormalities.
Tetraparesis refers to weakness affecting all four extremities. Hemihypesthesia refers to decreased sensation on one side of the body.
Conversion Disorder Diagnosis
Clinicians initially suspected conversion disorder based on:
- Absence of a typical neurologic pattern
- Positive Hoover sign
- Fluctuating motor deficits
- Recent stress and anxiety
The patient was treated with psychiatric medications.
However, her condition continued to worsen.
By day five, examination showed areflexia in all limbs.
Electromyography revealed a motor axonal neuropathy pattern.
Guillain-Barré Syndrome Considered
Based on EMG findings and cerebrospinal fluid analysis, Guillain-Barré syndrome was considered.
Spinal fluid showed albuminocytologic dissociation—a classic finding.
When common infectious triggers are absent, alternative causes—including Borrelia infection—should be considered.
Treatment with intravenous immunoglobulin led to partial improvement.
Lyme Disease Diagnosis
Further testing revealed positive Borrelia burgdorferi antibodies in blood and cerebrospinal fluid.
None of the typical Guillain-Barré triggers were identified.
This suggested a Lyme-associated neurologic process.
The patient was treated with intravenous ceftriaxone for 14 days, followed by improvement in motor function.
Rehabilitation was required for continued recovery.
Why This Pattern Matters
This case reflects a broader diagnostic pattern.
Neurologic Lyme disease can mimic both psychiatric conditions and autoimmune neurologic disorders.
Symptoms may appear inconsistent early, leading clinicians to consider functional or psychiatric explanations before infectious causes.
For symptom patterns, see Lyme disease symptoms guide.
Clinical Perspective
Progressive neurologic symptoms that worsen despite psychiatric treatment should prompt further evaluation.
Objective findings—such as EMG abnormalities or cerebrospinal fluid changes—can reveal underlying neurologic disease.
In Lyme-endemic regions, infectious causes should remain part of the differential diagnosis.
Clinical Takeaway
Neurologic Lyme disease can present with symptoms that resemble conversion disorder or Guillain-Barré syndrome.
Worsening symptoms, objective neurologic findings, and poor response to psychiatric treatment should prompt broader evaluation—including infectious causes.
Frequently Asked Questions
Can Lyme disease cause Guillain-Barré syndrome?
Yes. Guillain-Barré syndrome can develop as a post-infectious complication of Lyme disease, though this is rare.
Why was this patient initially diagnosed with conversion disorder?
Her symptoms included fluctuating deficits and stress-related factors, which can overlap with functional neurologic disorders.
How was the correct diagnosis made?
Progressive worsening, EMG findings, and cerebrospinal fluid analysis revealed a neurologic process linked to Borrelia infection.
How common is misdiagnosis?
Neurologic Lyme disease is frequently misdiagnosed when symptoms overlap with psychiatric or autoimmune conditions.
Related Reading
- Lyme Disease Misdiagnosis
- Lyme Disease and Autoimmune Disorders
- Can Lyme Disease Trigger Autoimmune Disease?
- Lyme Disease Mimicking Autoimmune Disease
References
- Teodoro T et al. Atypical Lyme Neuroborreliosis and Guillain-Barré Syndrome. Case Rep Neurol. 2019.
- Edelsohn G. Guillain-Barré misdiagnosed as conversion disorder. Hosp Community Psychiatry. 1982.
- Tyagi N et al. 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.