Lyme Meningitis and Radiculitis: A Neurologic Lyme Disease Case
Neurologic symptoms can escalate
Testing may be initially negative
Pain can become severe and radiating
Diagnosis may require spinal tap
Lyme meningitis and radiculitis can present with a wide range of neurologic symptoms—and may be missed early. This case highlights how central and peripheral nervous system involvement can evolve over time. :contentReference[oaicite:0]{index=0}
In this Inside Lyme Podcast, I discuss a 43-year-old man whose illness progressed from flu-like symptoms to severe neurologic dysfunction.
Early Symptoms: Easily Misinterpreted
The patient initially developed:
- Fever and fatigue
- Muscle aches
- Neck stiffness
- Headache and mild photophobia
He also had a rash but did not immediately receive a Lyme disease diagnosis.
Initial Lyme testing was negative, and the illness was presumed to be viral meningitis.
For early symptom patterns, see Lyme disease symptoms.
Progression to Neurologic Lyme Disease
Over the following month, symptoms worsened significantly:
- Severe radicular (shooting) pain
- Progressive weakness
- Tremors affecting hands and legs
- Imbalance and instability
- Emotional lability, anxiety, and depression
This reflects involvement of both the central nervous system (meningitis) and peripheral nervous system (radiculitis).
For related conditions, see neurologic Lyme disease.
What Is Lyme Radiculitis?
Radiculitis refers to inflammation of nerve roots in the peripheral nervous system.
It may cause:
- Severe, shooting pain
- Muscle weakness
- Loss of reflexes
- Sensory changes along nerve pathways
This type of pain is often intense and difficult to manage.
Diagnosis: Why It Was Delayed
Early testing did not confirm Lyme disease.
A definitive diagnosis was made only after a spinal tap showed:
- Lymphocytic pleocytosis
- Elevated protein
- Low glucose
These findings were consistent with Lyme meningitis.
This case highlights the limitations of early testing.
For more, see Lyme disease testing and diagnosis.
Treatment and Response
The patient was treated with:
- Doxycycline (initial course)
- Intravenous ceftriaxone (one month)
Within two weeks:
- Pain improved
- Weakness improved
- Mood symptoms stabilized
Some gait and mobility issues persisted.
Why This Case Matters
This case demonstrates several key clinical points:
- Lyme disease can affect both CNS and PNS simultaneously
- Symptoms may evolve over weeks
- Early testing may be negative
- Neurologic symptoms may be severe and multifaceted
Delayed recognition can lead to more complex illness.
Clinical Takeaway
Lyme meningitis and radiculitis can present with progressive neurologic symptoms that are initially misdiagnosed.
When symptoms worsen or expand, clinicians should reconsider Lyme disease—even after negative early testing.
Timely recognition and treatment can lead to significant improvement.
Podcast Discussion Topics
- What is Lyme meningitis?
- What is Lyme radiculitis?
- Why was the diagnosis delayed?
- How do CNS and PNS symptoms overlap?
- What role do emotional symptoms play?
- How useful are spinal tap results?
- Could earlier treatment have helped?
This podcast is for educational purposes only and is not a substitute for medical advice.
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
