Lyme Disease and Stroke: An Inside Lyme Case Study

Welcome to an Inside Lyme case study. One of the best ways to understand Lyme disease is by reviewing real patient cases. In this Inside Lyme podcast, I discuss an 83-year-old man whose stroke was associated with Lyme disease.

Legast and colleagues first described this case in the journal Neurological Medicine in 2018.

Can Lyme Disease Cause a Stroke?

Although uncommon, Lyme disease can affect the nervous system and blood vessels in the brain. In rare cases, Lyme neuroborreliosis has been associated with ischemic stroke due to inflammation of cerebral blood vessels. When no other cause for a stroke is identified, physicians may consider Lyme disease as part of the evaluation, particularly in patients living in endemic regions or with a history of tick exposure.

Stroke Symptoms

An 83-year-old man was hospitalized with right-sided weakness and difficulty speaking. Brain CT and MRI scans revealed an ischemic stroke in the left corona radiata.

An ischemic stroke occurs when a blood vessel supplying the brain becomes blocked. A stroke affecting the corona radiata is sometimes called a lacunar stroke or small-vessel stroke because this region receives blood from small arterial branches.

The imaging also revealed a small lesion in the left parietal lobe. The parietal lobe plays an important role in processing sensory information, including touch, vision, and spatial awareness.

Because the stroke symptoms had developed over more than 24 hours, doctors were unable to administer clot-dissolving medication.

The patient had no evidence of common stroke risk factors such as hypertension, large-vessel disease, or a cardiac source of emboli.

Laboratory Findings

The man tested positive for a lupus anticoagulant. Lupus anticoagulants can be seen in autoimmune disorders as well as infections. Antiphospholipid antibodies have also been reported in a variety of illnesses, including chronic Lyme disease.

Lyme Disease and Stroke

When the patient’s history was reviewed more carefully, he recalled multiple tick bites over several years but did not remember developing a rash.

Two years earlier he had experienced tingling in his hands and feet that lasted for four months.

Doctors included Lyme disease testing as part of their evaluation. The patient tested positive for Lyme disease by ELISA and Western blot testing.

[bctt tweet=”Lyme disease can lead to stroke, although this complication appears to be rare.” username=”DrDanielCameron”]

A spinal tap also supported the diagnosis. Antibodies to Lyme disease in the spinal fluid were more than 27 times higher than those found in the blood, and the protein level in the spinal fluid was elevated.

The patient was diagnosed with probable Lyme neuroborreliosis.

Stroke is one of several neurologic complications reported in patients with neurologic Lyme disease.

Treatment and Outcome

The man was treated with intravenous ceftriaxone for 14 days.

After treatment, he was able to walk with a cane but continued to have severe weakness in his right arm.

Interestingly, his antiphospholipid antibodies became negative after six weeks.

Although strokes associated with Lyme disease have been reported, they appear to be rare and most documented cases have occurred in Europe.

The authors recommend considering Lyme disease in patients who:

• Live in or travel to endemic areas
• Have a history of tick exposure
• Develop stroke without another clear cause
• Have multiterritorial strokes or evidence of vasculitis

This patient had evidence of stroke in two locations.

What Can We Learn From This Case?

1. Lyme disease and stroke can be associated, although this complication appears to be rare.

Questions Raised by This Case

1. How often are Lyme disease and stroke associated?
2. Could earlier treatment for Lyme disease prevent some strokes?
3. Would the patient’s right-sided weakness have improved with a longer course of antibiotics?

Treating Tick-Borne Disease in My Practice

In my practice, each patient requires a careful and individualized assessment. I order a broad range of blood tests to evaluate other medical conditions in addition to tick-borne infections and arrange consultations with specialists when necessary.

Many patients are medically complex, as highlighted in this Inside Lyme podcast series.

Cases such as this remind clinicians to consider tick-borne infections when evaluating patients with unexplained stroke, particularly in regions where Lyme disease is common.

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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