Lyme Meningitis Symptoms and Radiculitis
Neurologic Lyme disease may affect the brain and nerves
Meningitis and radiculitis may occur together
Early recognition may improve recovery
Neurologic Lyme disease can involve both the central nervous system and peripheral nervous system. Patients may develop meningitis, radiculitis, or both — creating a confusing clinical picture that may initially resemble viral illness or another neurologic condition. These presentations are often discussed more broadly under neurologic Lyme disease.
One published case highlights how delayed recognition can complicate diagnosis and treatment. A 43-year-old man developed both Lyme meningitis and radiculitis after an illness initially thought to represent viral meningitis.
What Are Lyme Meningitis Symptoms?
Lyme meningitis symptoms may overlap with viral infections and other neurologic illnesses.
Symptoms can include:
- Headache
- Neck stiffness
- Photophobia
- Fatigue
- Fever
- Malaise
- Muscle aches
- Cognitive changes
- Balance problems
In the published case, the patient initially developed fever, anorexia, fatigue, neck stiffness, photophobia, headache, and diffuse constitutional symptoms before progressing neurologically.
What Is Lyme Radiculitis?
Lyme radiculitis refers to inflammation affecting spinal nerve roots. Symptoms can be severe and may mimic orthopedic, neurologic, or degenerative conditions.
Common symptoms include:
- Lancinating or shooting pain
- Numbness or tingling
- Weakness
- Muscle wasting
- Reduced reflexes
- Sensory changes
- Difficulty walking
Radiculitis involving the peripheral nervous system may occur alone or alongside central nervous system involvement. Severe radicular pain and weakness developed as this patient’s illness progressed.
Can Lyme Disease Cause Meningitis?
Yes. Lyme disease may cause meningitis when infection involves the central nervous system.
Patients may present with:
- Persistent headache
- Neck pain or stiffness
- Light sensitivity
- Cranial nerve involvement
- Cognitive symptoms
- Neurologic deficits
Because symptoms overlap with viral illness and many neurologic disorders, delayed recognition is common. Patients with meningitis or radicular pain may initially receive alternative diagnoses, contributing to delayed Lyme disease diagnosis.
Why Lyme Meningitis Can Be Missed
Diagnosis may be delayed because:
- Initial Lyme testing may be negative
- Symptoms overlap with viral meningitis
- Rashes may be atypical
- Neurologic symptoms evolve gradually
- Patients may initially decline lumbar puncture testing
Extensive laboratory testing initially failed to identify Lyme disease in this case. The patient was presumed to have viral meningitis before worsening neurologic symptoms prompted additional evaluation. This diagnostic uncertainty overlaps with broader challenges involving Lyme disease misdiagnosis.
CSF Findings in Lyme Meningitis
When lumbar puncture is performed, cerebrospinal fluid findings may support the diagnosis.
Typical abnormalities may include:
- Lymphocytic pleocytosis
- Elevated protein
- Abnormal glucose levels
- Evidence of intrathecal inflammation
The patient’s spinal fluid showed lymphocytic pleocytosis with elevated protein and reduced glucose, findings consistent with neurologic involvement.
Treatment and Recovery
The patient described in the report received doxycycline followed by intravenous ceftriaxone.
Within several weeks, pain, weakness, constitutional symptoms, and mood-related symptoms improved substantially, although residual walking difficulties remained.
Recovery following neurologic Lyme disease varies considerably and may depend on timing of diagnosis, severity, and coexisting neurologic injury.
Frequently Asked Questions
What are Lyme meningitis symptoms?
Common symptoms include headache, neck stiffness, photophobia, fatigue, fever, and neurologic changes.
Can Lyme disease cause meningitis?
Yes. Lyme disease can involve the central nervous system and cause meningitis.
What is Lyme radiculitis?
Lyme radiculitis is inflammation affecting spinal nerve roots, often leading to severe pain, weakness, or sensory symptoms.
Can Lyme meningitis mimic viral meningitis?
Yes. Early Lyme meningitis may resemble viral illness, delaying diagnosis.
Can Lyme disease affect both the brain and peripheral nerves?
Yes. Central nervous system and peripheral nervous system manifestations may occur together.
Clinical Takeaway
Neurologic Lyme disease may involve both meningitis and radiculitis, creating a complicated presentation that overlaps with many other disorders.
Persistent headache, neck stiffness, radicular pain, weakness, and evolving neurologic symptoms should raise suspicion for neurologic Lyme disease when the clinical picture fits.
Related Articles
These related articles explore neurologic manifestations, diagnostic delays, and overlapping symptoms seen in neurologic Lyme disease.
Lyme Disease Symptoms Guide
Persistent Lyme Disease Mechanisms
Post-Treatment Lyme Disease Syndrome
Recovery From Lyme Disease
Lyme Disease Fatigue
References
- Dabiri I, Calvo N, Nauman F, Pahlavanzadeh M, Burakgazi AZ. Atypical presentation of Lyme neuroborreliosis related meningitis and radiculitis. Neurol Int. 2019;11(4):8318.
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
