Can Lyme Disease Cause Stroke? What to Know About Lyme Neuroborreliosis
You have stroke symptoms—but no clear risk factors.
It doesn’t fully make sense.
Lyme disease may be an overlooked cause.
Stroke is not usually associated with Lyme disease. But in some cases, Lyme neuroborreliosis (LNB) can affect blood vessels in the brain and lead to stroke-like symptoms.
This is where diagnosis can be missed—particularly in patients without traditional cardiovascular risk factors.
Learn more in our Lyme disease symptoms guide.
In a systematic review of published cases, Garkowski and colleagues examined patients with cerebrovascular complications related to Lyme disease (Garkowski et al., 2017).
Who Is Affected by Lyme-Related Stroke?
What did this look like in real patients?
More than half of reported cases came from Europe, including:
- Germany (25.4%)
- Switzerland (14.3%)
- France (12.7%)
Cases were also reported in the United States (8%).
Patients ranged in age from 4 to 77 years, with a median age of 46.
More than half were under the age of 50—including 15 pediatric cases.
Males accounted for 54% of cases.
This highlights an important pattern: Lyme-related stroke can occur in younger patients who would not typically be considered at risk.
What Types of Stroke Occur in Lyme Disease?
In this review, ischemic stroke was the most common presentation (76.1%), followed by transient ischemic attack (11.4%) (Garkowski et al., 2017).
Different regions of the brain were affected:
- Posterior circulation alone (37.8%)
- Anterior circulation alone (24.4%)
- Both anterior and posterior circulation (37.8%)
This variability can make diagnosis more challenging.
What Are the Outcomes?
What happens after diagnosis depends on how quickly Lyme disease is recognized.
- 75% had a complete response to antibiotic treatment
- 20% had incomplete recovery or residual neurologic deficits
- Mortality rate was 4.7%
A complete response was defined as halted disease progression and recovery from neurologic deficits.
Early recognition can significantly improve outcomes.
Why Is Lyme-Related Stroke Missed?
This is where things become more complicated.
Many patients experienced symptoms weeks or months before stroke onset.
These early signs—often overlooked—included:
- Meningitis-like symptoms
- Cranial nerve involvement
- Radiculoneuritis (nerve root inflammation)
These prodromal symptoms may suggest Lyme neuroborreliosis, but are not always recognized.
Delayed diagnosis can lead to serious complications—including stroke.
When Should Lyme Disease Be Considered in Stroke?
Lyme disease should be considered when:
- Stroke occurs in younger patients without clear risk factors
- Neurologic symptoms precede stroke
- There is possible exposure to tick-endemic areas
In these cases, further evaluation—including cerebrospinal fluid testing—may be necessary.
Clinical Takeaway
Lyme neuroborreliosis can lead to stroke—particularly in patients without typical cardiovascular risk factors.
Early neurologic symptoms may provide a critical window for diagnosis.
If stroke symptoms don’t fit the usual pattern, it’s worth asking why—again.
Related Reading
At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment
What happens to the brain during acute Lyme neuroborreliosis?
References
- Garkowski, A., Zajkowska, J., Zajkowska, A., et al. (2017). Cerebrovascular manifestations of Lyme neuroborreliosis: A systematic review of published cases. Frontiers in Neurology, 8, 146.
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
hi doc 😉
very interesting article! around 15 years ago when i was still trying to get a correct diagnosis for my MISDIAGNOSIS of chronic lyme, i had a mri done.
it showed a MINI-STROKE with “old blood”. since i was misdx for 35 years, this stroke could have occurred during this time period.
is there some type of guideline to determine how long it’s been since any patient had a stroke? thanks doc!
betty gordon
iowa fan of yours 😉 didn’t get a chance to introduce myself at fall st. paul lda conference!
Good question. At least we are having a conversation.
I have had Lyme disease with Ehrlichia since 2012. An MRI said I had a stoke and a spinal tap revealed rare white blood cells. I am still sick after being put on a PICC line and 4 1/2 years of antibiotics. I suffer confusion, headaches, stiff neck, nausea,and extreme weaknesses and fatigue, nausea and severe brain fog. My head hurts so bad at the back of my head. I would like to be evaluated by the Dr. I have made no improvement in my condition. My skin burns and stings.
Please get back with me.
It is difficult to tell whether a different approach might work. Feel free to call the office at 914 666 4665 if you have any questions.
I’m very interested in understanding more. Feb 2017 I had at stroke at 42 years old and the 0nly thing I have going on with my health was a newer (~6 month) infection with Lyme. All my doctors are not in alignment with my neurologist who said Lyme caused my stroke. I’m at odds wondering if that is the true cause of the stroke.
It can be difficult to determine the cause of a stroke. You may find that well trained doctors can reach different conclusions. Make sure you are thoroughly evaluated for all causes. You might benefit from a second look a a tick borne illness.
I was diagnosed in 2013 with Lyme disease but I believe based on my symptoms that mostly have gone away after 4 years of IV antibiotics that I got lyme disease as long ago as 1995 or before. I had an MRI done in 2016 which showed an old stroke surrounded by a large area of gliosis. My blood vessels were clean at the time of the MRI without any athlerosclerosis. Is it possible that the stroke occurred slowly over time? Or did it have to have occurred suddenly? I had no obvious symptoms such as weakness on the opposite side so I have no idea when it occurred
It is hard to tell if a white spot is demyelination or a stroke. Your doctors may offer insight.
I live in West Tx.I was diagnosed with chronic Lyme in 2008 believe to then have a 2nd infection, 1sts one in 1997. The 1st see of August 2018I had 5 new tick bites from the East in TN,NC,SC. Whithin 2 to 4 weeks I started having n nueroligical symptoms that increased daily. I have had 3 strokes in a week and a half. Im only 53 single mom off a13 yr old. Lyme is not recognized here, no one will listen or is helping me. I desperately need a doc too treat me. I’m begging for your help,, please!!!
I have written a couple Lyme disease science blogs to better understand the clinical presentations where stroke was described as a manifestations of Lyme disease. It is important to always rule out other cases of stroke. You should try and find a doctor experienced in treating Lyme disease as part of your evaluation. It can be hard to find an experienced doctor in many areas of the country.
I hope by now that your child has seen a Lyme doctor, and that the strokes are gone. I would suggest finding a LLMD at ILADS.com. There is an area where you can find a doctor in your area = Tools and Resources. Prayers for you and your child.
My husband got lyme disease three years ago. Within the first year it came back with more severe symptoms. Was treated again with antibiotics. Within the 2nd year he came down with type 2 diabetes suddenly. Within the third year he had a stroke. Has recovered for the most part but still has hearing problems and neurologic issues. I believe all these illnesses is a result of him contracting Lyme Disease
My friend just died from a stroke at age 61. She had Lyme Disease and was dealing with a moldy rental.
I am sorry for your loss.