Lyme Disease Linked to Stroke in a 9-Year-Old Boy

Lyme disease can occasionally cause serious neurologic complications in children. This case report describes a 9-year-old boy who developed a stroke associated with Lyme neuroborreliosis.

Challenges diagnosing neurologic Lyme disease are discussed further in the Testing & Diagnosis guide. Neurologic symptoms such as dizziness, weakness, tremor, and cognitive changes are also reviewed in the Lyme disease symptoms guide.

“Recent data suggest that infection either directly or indirectly plays a major role in the pathogenesis of childhood acute ischemic stroke,” states Monteventi, from the Pediatric Neurology Unit at Geneva Children’s Hospital in Switzerland. [1] The goal of this study was to “identify all children who suffered from a stroke that can be attributed with confidence to Lyme disease.”

Their review uncovered 229 children treated for stroke. Out of those 229, four children had strokes believed to be caused by Lyme neuroborreliosis. One of those cases involved a 9-year-old boy.

According to the authors, the boy, who was evaluated at an emergency department, complained of tiredness, pain, numbness and a low-grade fever – all which resolved in 3 days. He had no history of a tick bite or rash. He did have positive titers against B. burgdorferi (both IgG and IgM), but those were presumed to be related to an earlier infection when he was treated for an erythema migrans rash at age 7. His neurologic findings were normal, and he was discharged with no treatment.

Two months later, the boy was re-admitted to the hospital complaining of vomiting and vertigo. His exam revealed a subtle bilateral tremor. “A brain MRI was performed and showed two fresh right cerebellar micro-infarcts in the right PICA territory as well as narrowing of both vertebral arteries and the basilar artery,” says Monteventi.

Serologic and cerebral spinal fluid (CSF) results were positive for Lyme disease. Serological studies showed elevated B. burgdorferi IgM and IgG titers that were confirmed by a positive Western Blot. CSF analysis revealed a lymphocytic pleocytosis, mildly elevated protein content, low glucose, and intrathecal synthesis of both B. burgdorferi IgM and IgG.

The boy was prescribed IV Ceftriaxone (2 g/day) for 2 weeks, oral corticosteroids tapered for 7 weeks and preventive Aspirin (100 mg/day) for 8 months. He recovered rapidly.

Lyme neuroborreliosis is a neurologic form of Lyme disease that can affect the brain, spinal cord, or surrounding blood vessels. In rare cases, vascular inflammation related to infection may contribute to stroke.

The authors describe case reviews for three other children. But this case, in particular, reminds us that some individuals with a positive IgM Western Blot test may be a true positive test even if their initial symptoms are not specific.

As Monteventi points out, “The strong predilection towards posterior cerebral circulation with clinical occurrence of brainstem signs associated with meningeal symptoms and CSF lymphocytosis are suggestive features that should rapidly point to the diagnosis.”

“Clinicians must be aware of this rare neurological complication of Lyme disease that demands specific antibiotic treatment,” says Monteventi.

Although stroke is a rare complication of Lyme disease, clinicians should consider tick-borne infection when neurologic symptoms appear in children living in endemic areas.

Neurologic complications in children are discussed further in the Pediatric Lyme disease guide.

Clinical Takeaway

This case illustrates how Lyme disease may rarely contribute to stroke in children through neurologic involvement. Recognition of unusual neurologic symptoms and appropriate testing can help ensure timely treatment.

Related Articles:

Stroke as a manifestation of Lyme disease

When Lyme disease mimics a heart attack

At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment

Seizures and altered mental status after a tick bite

References:

1. Monteventi O, Steinlin M, Regenyi M, Roulet-Perez E, Weber P, Fluss J. Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review. Eur J Paediatr Neurol. 2018;22(1):113-121.