Can Lyme Disease Cause Brain Inflammation? A Rare Case With MRI Changes
Lyme can affect the brain.
Inflammation may appear on MRI.
Even without a rash or tick bite.
Lyme disease can affect the brain and, in rare cases, cause inflammation in the central nervous system.
This may lead to symptoms such as brain fog, memory problems, tremors, imbalance, and vision changes.
Start here: Lyme disease symptoms guide
Can Lyme Disease Cause Brain Inflammation?
Yes, Lyme disease can cause brain inflammation, particularly in cases of neuroborreliosis.
This inflammation may involve different parts of the brain and can sometimes be detected on MRI.
This type of inflammation may be described as encephalitis, although it is rare in Lyme disease.
Neurological involvement in Lyme disease is well recognized, even when imaging findings are subtle.
A Rare Case of Lyme Brain Inflammation
In their case report, Svingen and colleagues described a patient with Lyme disease affecting the rhombencephalon, also known as the hindbrain.
This is a rare presentation of neuroborreliosis.
The patient experienced an 8-month history of symptoms, including:
- Fatigue
- Headaches
- Night sweats
- Weight loss
- Double vision
- Tremors
- Numbness and tingling
- Unsteady gait
- Memory problems
Notably, she did not recall a tick bite or rash.
This broad range of symptoms can make diagnosis difficult.
What the MRI Showed
An MRI revealed inflammation in the rhombencephalon, a region of the brain involved in balance, coordination, and eye movements.
This helps explain symptoms such as double vision, tremors, and an unsteady gait.
This type of inflammation is extremely rare in Lyme disease.
However, it demonstrates that Lyme infection can affect deeper brain structures.
How the Diagnosis Was Confirmed
Testing identified Borrelia burgdorferi–specific IgM and IgG antibodies.
The diagnosis of neuroborreliosis was supported by both clinical symptoms and imaging findings.
Response to Treatment
The patient was treated with intravenous ceftriaxone for 4 weeks.
Her symptoms improved significantly.
Follow-up MRI scans showed near-complete resolution of the inflammation and eventual normalization.
This supports that the brain changes were related to infection rather than permanent damage.
What This Means for Lyme Disease in the Brain
Although rhombencephalitis is rare, this case highlights an important principle:
Lyme disease can affect the brain in ways that are not always typical or expected.
Neurological symptoms may occur even without classic Lyme features such as rash or joint pain.
Clinicians may need to consider Lyme disease when evaluating unexplained neurological symptoms, especially in endemic areas.
Learn more: brain fog and inflammation in Lyme disease
Other Causes of Brain Inflammation
Rhombencephalitis is more commonly caused by other infections, including:
- Listeria monocytogenes
- Enterovirus 71
- Herpes simplex virus
This makes Lyme disease an uncommon—but important—cause to consider.
Clinical Takeaway
Lyme disease brain inflammation is uncommon but possible.
When neurological symptoms are unexplained, Lyme disease may be part of the differential diagnosis—even in the absence of a rash or known tick bite.
Early recognition and treatment can lead to improvement and, in some cases, full resolution of imaging abnormalities.
Related Articles
- Lyme disease leads to a false brain tumor in a child
- Could cytokines contribute to brain fog in Lyme disease?
- Brain fog in COVID-19 and Lyme disease
References
- Svingen H, Orrem J, Nørgaard Eskesen A. Neuroborreliosis with involvement of rhombencephalon: A case report. IDCases. 2022.
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.