Can Lyme Disease Cause Brain Inflammation?
Lyme disease can rarely trigger brain inflammation
MRI changes may involve the hindbrain
Neurologic symptoms may improve with treatment
Lyme disease brain inflammation is uncommon, but case reports show that neuroborreliosis can occasionally involve regions of the brain such as the rhombencephalon, also known as the hindbrain.
In their article, “Neuroborreliosis with involvement of rhombencephalon: A case report,”1 Svingen and colleagues describe a rare presentation in which Lyme disease triggered inflammation of the rhombencephalon.
What are Lyme brain inflammation symptoms?
Over an 8-month period, the patient experienced intermittent fevers, dry cough, fatigue, headaches, night sweats, unintentional weight loss of about 15 lbs., double vision, a tremor in the neck, paresthesia and tremor in the extremities, unsteady gait, and memory loss.
Approximately 4 weeks before symptom onset, the woman had been vacationing in a Lyme-endemic region of Norway. However, she did not recall a tick bite or rash.
These symptoms highlight how neurologic Lyme disease may present with both systemic and central nervous system manifestations.
Lyme disease brain MRI findings
“An MRI scan demonstrated pathology in rhombencephalon with quite symmetric T2 hyperintensity involving capsula interna bilaterally, extending through mesencephalon to pons,” the authors wrote.
Borrelia burgdorferi-specific IgM and IgG antibodies were identified using chemiluminescence immunoassay.
Brain MRI findings in Lyme disease are often nonspecific or normal, but rare cases may show inflammatory changes involving the brainstem, white matter, or other central nervous system structures.
An MRI scan revealed inflammation in the rhombencephalon, also referred to as the hindbrain, which the authors described as extremely rare in patients with Lyme disease.
Can Lyme disease cause encephalitis?
Lyme disease can rarely present with central nervous system inflammation. In this case, the authors diagnosed neuroborreliosis with rhombencephalitis after neurologic symptoms and MRI findings improved with treatment.
Rhombencephalitis is more commonly linked to infections such as Listeria monocytogenes, Enterovirus 71, and Herpes simplex virus.
The authors noted that it is “exceedingly rare” to find Borrelia burgdorferi as an infectious cause of rhombencephalitis.
Treatment and recovery
The patient was treated successfully for 4 weeks with intravenous ceftriaxone.
“The MRI findings in rhombencephalon had almost disappeared,” according to the authors. Seven months later, a follow-up MRI “was completely normal, and she had further improvement of her symptoms.”
The authors suggest, “Significant improvement of neurological symptoms and resolution of the MRI findings after proper treatment confirmed the diagnosis neuroborreliosis with rhombencephalitis.”
Why this case matters
This case illustrates why Lyme disease may need to remain in the differential diagnosis when patients present with neurologic symptoms and MRI findings suggesting central nervous system inflammation.
Furthermore, the authors recommend that neuroborreliosis should be considered among the differential diagnoses in patients with neurologic symptoms and findings suggesting inflammation in the central nervous system despite unusual or normal neuroimaging findings.
Read more about neurologic Lyme disease and how Lyme disease affects the brain.
Frequently Asked Questions
Can Lyme disease cause brain inflammation?
Yes. Lyme disease can rarely cause central nervous system inflammation, including unusual cases involving the hindbrain.
What are Lyme brain inflammation symptoms?
Symptoms may include headaches, double vision, tremor, unsteady gait, memory problems, fatigue, fever, and neurologic complaints.
Can Lyme disease show up on a brain MRI?
In some cases, MRI may show abnormalities, but imaging findings can also be normal or nonspecific.
Can Lyme disease cause encephalitis?
Rarely, Lyme neuroborreliosis may present with encephalitis or rhombencephalitis, although this is unusual.
Can Lyme brain inflammation improve with treatment?
In this case report, neurologic symptoms improved and MRI findings resolved after intravenous ceftriaxone treatment.
Clinical Takeaway
Lyme disease brain inflammation is rare, but this case demonstrates that neuroborreliosis can occasionally involve the hindbrain and produce significant neurologic symptoms.
Clinicians should consider neuroborreliosis when neurologic symptoms and MRI findings suggest central nervous system inflammation, even when the presentation is unusual.
Related Articles
Lyme disease leads to false brain tumor in young child
Could cytokine storms lead to brain fog in Lyme disease patients?
Neurologic Lyme disease
Brain fog and Lyme disease
References
- Svingen H, Orrem J, Nørgaard Eskesen A. Neuroborreliosis with involvement of rhombencephalon: A case report. IDCases. 2022;28:e01472.
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
I had the same experience 100%!!!
I, too, had the same experience, and excruciating pain and swelling of the occipital region . It has taken years for this to improve and has not yet resolved completely.
I’ve had chronic lyme disease for the last 4 years, but i’ve been on multiple antibiotics, would this occur if I went off the antibiotics?
The blog discusses a case report of an a patient who had never been treated. I would appreciate more information on what is happening to the brain in individuals with tick borne illnesses who stay ill.