Neck Pain After a Tick Bite: A Missed Neurologic Sign of Lyme Disease
Neck pain after a tick bite may signal neurologic Lyme disease
Radiculoneuritis can occur even without meningitis or Bell’s palsy
Delayed recognition may postpone appropriate treatment
A child presented with fatigue, posterior neck pain, and a low-grade fever without a known tick bite, erythema migrans rash, or Bell’s palsy—classic signs often associated with Lyme disease.
Despite the absence of these findings, the child was ultimately diagnosed with neurologic Lyme disease due to radiculoneuritis, an underrecognized inflammatory condition affecting spinal nerve roots.
The case highlights how neck pain after a tick bite—or even without a remembered tick bite—may represent an early neurologic manifestation of Lyme disease.
Neck Pain as a Neurologic Symptom of Lyme Disease
The child developed pain involving the soft tissues of the posterior neck and upper back.
An MRI of the cervical spine with gadolinium contrast demonstrated questionable nerve root enhancement at levels C5-C6 and C6-C7, findings consistent with cervical radiculitis.
The initial presumptive diagnosis was viral cervical radiculitis rather than Lyme disease.
Two days later, Lyme disease testing returned positive by both IgG and IgM Western blot, and the child improved after treatment with doxycycline.
Learn more about neurologic Lyme disease symptoms.
What Is Radiculoneuritis?
Radiculoneuritis refers to inflammation of spinal nerve roots and may cause:
- Neck or back pain
- Burning or shooting nerve pain
- Pain radiating into the arms or legs
- Abnormal sensations or tingling
- Weakness in severe cases
Lyme neuroborreliosis classically includes meningitis, cranial neuropathy, and radiculoneuritis, although isolated radiculoneuritis may occur without other neurologic findings.
Why Lyme Radiculoneuritis Is Often Missed
Radiculoneuritis remains uncommon in North America and may be mistaken for viral illness, musculoskeletal strain, or orthopedic injury.
In this case, there was no meningitis, Bell’s palsy, or classic rash to immediately suggest Lyme disease.
Delayed diagnosis may occur because neurologic Lyme disease can present with isolated pain syndromes before more recognizable symptoms develop.
These diagnostic delays overlap with patterns seen in delayed Lyme disease diagnosis.
MRI Findings in Lyme Radiculoneuritis
MRI abnormalities may not be identified unless imaging is performed with contrast.
The authors emphasized that gadolinium-enhanced MRI may help detect inflammation involving spinal nerve roots.
However, MRI is often ordered primarily to exclude other neurologic or structural conditions rather than to confirm Lyme disease itself.
Neck Pain After a Tick Bite Should Not Be Ignored
Neck pain after a tick bite may raise concern for several Lyme-related neurologic complications, including meningitis, radiculitis, or neuroinflammation.
Persistent neck pain accompanied by fatigue, fever, headaches, dizziness, or neurologic symptoms deserves careful evaluation—particularly in endemic regions.
Some patients with neurologic Lyme disease may also experience symptoms involving autonomic dysfunction, including dizziness or exercise intolerance.
Frequently Asked Questions
Can Lyme disease cause neck pain?
Yes. Lyme disease may cause neck pain through meningitis, muscle inflammation, or neurologic complications such as radiculoneuritis.
What is Lyme radiculoneuritis?
Lyme radiculoneuritis is inflammation of spinal nerve roots caused by neurologic Lyme disease and may produce severe neck, back, or nerve pain.
Can neck pain occur without a Lyme rash?
Yes. Some patients with neurologic Lyme disease never develop or recognize a rash.
Why is neurologic Lyme disease sometimes missed?
Symptoms may resemble viral illness, orthopedic injury, or nonspecific pain syndromes, especially when classic Lyme findings are absent.
Does Lyme radiculoneuritis improve with treatment?
Many patients improve with appropriate antibiotic therapy, particularly when diagnosis and treatment occur early.
Clinical Takeaway
Neck pain after a tick bite may represent an early neurologic manifestation of Lyme disease even when classic findings such as rash, meningitis, or facial palsy are absent.
Persistent neck pain accompanied by fatigue, fever, or neurologic symptoms deserves careful evaluation in patients at risk for tick-borne illness.
Related Articles
These related articles explore neurologic Lyme disease, delayed diagnosis, meningitis, and persistent symptoms linked to tick-borne infection.
Lyme disease symptoms guide
Meningitis and radiculitis in Lyme disease
Lumbar puncture and Lyme neuroborreliosis
Post-Treatment Lyme Disease Syndrome (PTLDS)
Lyme disease misdiagnosis
References
- Baker AL, Mannix R, Baker AH. Radiculoneuritis due to Lyme disease in a North American child. Am J Emerg Med. 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
This is so interesting. The same thing happened to me. The most excruciating pain in my neck. I spent 6 weeks seeing different doctors, had MRI’s, took heavy dose pain killers and nothing helped. Finally, my doctor put me on Prednisone because they thought I had PMR. Then, frozen shoulder, back pain, shingles. Finally, after 6 weeks of no sleep a Rheumatologist took a Lyme test and bang, all bands CDC positive. 6 weeks of Doxy, 30 days IV and now I’m left with severe nerve pain and neuropathy on my left side of body. I haven’t found anything to help! One doctor told me Bannwarth syndrome.
Anyone else with similar situation? Any suggestions? I would like to find a LLMD that has experience in the treatment of nerves.
Thank you
Deal with neck and back pain after months of antibiotics! My spinal tap showed spirochetes I have NeuronLyme. I’m now Chronic. Got bit in the early ‘ops and again in 2014/with multiple coinfections
Peeling back the layers of Lyme disease unveils an intricate tapestry where not every thread adheres to the familiar patterns of Bell’s palsy or the tell-tale rash. The tale of a 10-year-old boy, beset by a shadowy pain in the nape of his neck, leads us down a serpentine path of medical detective work. No tick bite in sight, no erythema migrans rash to point the way—only the subtle whispers of an MRI hinting at radiculitis. In this ever-evolving medical landscape, Lyme disease emerges, not just as an ailment, but as a reminder that diseases, like stories, have multiple narratives. How enlightening to think that amidst the cacophony of symptoms, sometimes the most muted ones, like isolated radiculoneuritis, can herald the most profound revelations. The journey of diagnosis and treatment, as illuminated here, is as much an art as it is a science.