Can Lyme Disease Cause a Stroke?
Stroke is a rare complication of Lyme neuroborreliosis
A case report describes ischemic stroke with confusion and aphasia
Neurologic symptoms improved after treatment with IV ceftriaxone
Can Lyme disease cause a stroke? Although uncommon, Lyme neuroborreliosis has been associated with ischemic stroke in rare case reports. This case describes a 59-year-old man whose stroke and neurologic symptoms improved following treatment for Lyme disease.
Although uncommon, Lyme neuroborreliosis may present with stroke-like symptoms including confusion, aphasia, weakness, and cognitive changes.
Ischemic Stroke Associated With Lyme Neuroborreliosis
The study entitled “Ischemic Stroke With Hemorrhagic Conversion in a Case of Lyme Neuroborreliosis” by Sathi and colleagues describes the case of a 59-year-old man who presented to a hospital in Florida with ischemic stroke, aphasia, and acute confusion that had been ongoing for two days.
The patient had a medical history which included atrial fibrillation on apixaban, coronary artery disease, hypertension, and type 2 diabetes mellitus.
He resided in Michigan and reportedly exhibited a rash 10 years earlier which was not evaluated by a physician because it had disappeared.
This would be the sixth reported case in the United States of Lyme neuroborreliosis concurrent with ischemic stroke where Lyme disease may have been causal.
Why Lyme Disease Was Suspected
“Lyme disease was suspected due to the patient’s history, travel from an endemic area, and MRI findings that were remarkable for multiple foci of abnormal signal intensity in the cerebral white matter,” the authors wrote.
MRI findings demonstrating multiple white matter abnormalities contributed to the suspicion that Lyme neuroborreliosis might be involved.
A spinal tap was performed which was positive for Borrelia burgdorferi IgM and IgG antibodies and varicella-zoster virus (VZV) IgG.
Other imaging revealed that the patient had suffered an ischemic stroke with hemorrhagic conversion.
The combination of the patient’s travel history, MRI findings, cerebrospinal fluid testing, and positive Lyme serologies increased suspicion for Lyme neuroborreliosis.
Response to Treatment
The patient was prescribed IV ceftriaxone for 30 days for Lyme disease.
“As the hospital course progressed, the patient began to improve in his receptive aphasia and encephalopathy,” the authors wrote.
“On day 14, prior to discharge, a repeat CT of the brain was negative for any evolution of the hemorrhagic conversion and the patient was alert, oriented, and could respond to questions and follow commands,” according to the authors.
Neuroborreliosis should be considered in the differential diagnosis of patients who present with stroke or acute confusional states in Lyme-endemic regions.
The man’s wife reported that follow-up outpatient imaging demonstrated resolution of the white matter signal abnormalities with continued improvement in the patient’s symptoms. However, a degree of receptive and expressive aphasia persisted.
According to the authors, the patient was able to resume his job and perform normal daily activities.
Can Lyme Disease Cause a Stroke?
The authors suggest that neuroborreliosis should be considered in the differential diagnosis of patients who present with stroke or acute confusional states in endemic areas of Lyme disease.
Because this is a single case report, it cannot establish that Lyme disease caused the stroke. However, the authors believed Lyme neuroborreliosis should be considered when evaluating patients with unexplained neurologic findings.
Although stroke remains an uncommon manifestation of Lyme disease, this case adds to a small number of reports describing ischemic stroke associated with Lyme neuroborreliosis.
Frequently Asked Questions
Can Lyme disease cause a stroke?
Rare case reports have described ischemic stroke associated with Lyme neuroborreliosis. These cases are uncommon but have been reported in the medical literature.
What is Lyme neuroborreliosis?
Lyme neuroborreliosis occurs when Lyme disease affects the nervous system and may cause meningitis, cranial neuropathies, radiculopathy, cognitive symptoms, or other neurologic manifestations.
Can Lyme disease cause stroke-like symptoms?
Lyme neuroborreliosis may present with confusion, aphasia, weakness, or other neurologic symptoms that can resemble stroke.
Clinical Takeaway
This case adds to a small number of reports describing ischemic stroke associated with Lyme neuroborreliosis. Although stroke remains an uncommon manifestation of Lyme disease, the diagnosis should be considered when patients from endemic regions present with unexplained stroke, acute confusion, or other neurologic findings.
Although rare, Lyme neuroborreliosis should be considered when evaluating unexplained stroke or stroke-like symptoms in patients from Lyme-endemic regions.
Related Articles
Untreated Lyme Disease Triggers a Stroke in a 9-Year-Old Boy
Stroke as a Manifestation of Lyme Disease
Neurologic Lyme Disease
Brain Fog and Lyme Disease
References
- Sathi S, Kim D, Duplan P, Kim P, Shenkamn C. Ischemic Stroke With Hemorrhagic Conversion in a Case of Lyme Neuroborreliosis. Cureus. 2022;14(8):e28028.
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 a stroke from Lyme as well; but highly doubt it was ever recorded as such? Don’t even know where to start to get that info to the right people?
I was pleased that there are a few cases reports that have been published. I hope my blog encourages further work on this subject.
Me too Dr Cameron.
I had a a “supposed” stoke in 2015. I was getting progressively ill since 2007 and had suggested to my family doctor the possibility offli lyme disease ( I removed an engorged tick and had red circle rash on my outer calf). He dismissed it. I had facial palsy from 2011 to 2017, but no treatment. In 2015 presented at the ER with progressive numbness in the foot and hand. Over the course of 24 hours I went completely numb on the right side. It was stated I had a white matter lesion on my thalamus and that I had experienced a posterior arterial blockage resulting in an infarct. To this day I am not sure if it was a stroke or a lesion from the Lyme infection. The neurologist said it was an ischemic stroke, but Lyme disease was never considered at first and when I mentioned it to my neurologist, he said, “he was not convinced” and that we all have Lyme disease in our system don’t we through exposure. Also, he said, the ND treating me for Lyme disease was ripping me off. Needless to say. I got rid of him.
Thanks for sharing. BTW white spots are common in a number of conditions besides stroke and Lyme disease. Some people can have Lyme disease and a stroke. The neurologist cannot do much about the stroke. I have had patients who have had both conditions.
Dr Cameron thank you for your reply. Can a Lyme lesion appear as an infarct on an MRI or be confused to be an ischemic stroke. What is the difference in representation on the MRI?