Lyme Disease and Spinal Cord Inflammation: A Transverse Myelitis Case

Spinal cord inflammation can cause serious neurologic dysfunction
Lyme disease can rarely involve the spinal cord
One case involved transverse myelitis, papilloedema, and visual symptoms

Yes, although it is uncommon. Lyme neuroborreliosis can rarely cause inflammation within the spinal cord, known as transverse myelitis. Symptoms may include weakness, numbness, pain, difficulty walking, and bowel or bladder dysfunction.

Subacute transverse myelitis is a neurologic syndrome caused by inflammation within the spinal cord. It may be associated with infections, autoimmune disorders, vascular disease, and other inflammatory conditions. Borrelia burgdorferi, the bacterium that causes Lyme disease, is among the infectious triggers reported.¹

Transverse myelitis can damage myelin and nerve fibers within the spinal cord, leading to weakness, sensory changes, gait abnormalities, pain, and autonomic dysfunction.

Although uncommon, Lyme disease affecting the spinal cord is clinically important because delayed recognition may prolong neurologic symptoms or complicate recovery.

For a broader overview of neurologic complications, see neurologic Lyme disease.

Can Lyme disease affect the spinal cord?

Lyme neuroborreliosis can rarely involve the spinal cord, leading to inflammatory complications such as myelitis.

Reported manifestations include spinal cord inflammation, sensory disturbances, weakness, gait abnormalities, autonomic dysfunction, and spinal cord lesions visible on MRI.

Lyme disease is not considered a cause of spinal stenosis. Spinal stenosis generally results from structural narrowing around the spinal cord or nerve roots, while transverse myelitis involves inflammation within the spinal cord. However, Lyme neuroborreliosis can rarely produce spinal cord symptoms or MRI abnormalities that require differentiation from structural spine disease.

Infectious or parainfectious causes are estimated to account for approximately 12% of transverse myelitis cases. Borrelia burgdorferi is among the infectious triggers reported.²

Typical symptoms associated with transverse myelitis include bilateral or unilateral limb weakness, sensory disturbances, gait changes, pain, and autonomic dysfunction.

Approximately one-third of patients with transverse myelitis report a febrile illness near symptom onset.¹

MRI findings in Lyme-associated transverse myelitis

MRI abnormalities may include spinal cord swelling, longitudinal lesions involving multiple spinal segments, or inflammatory changes within the spinal cord.

Imaging findings alone are not diagnostic. They require correlation with the patient’s symptoms, neurologic examination, cerebrospinal fluid findings, laboratory studies, and evaluation for other infectious, inflammatory, structural, and autoimmune causes.

Symptoms of transverse myelitis in Lyme disease

Symptoms vary depending on which regions of the spinal cord are involved.

• Weakness affecting the arms or legs
• Numbness, tingling, or sensory loss
• Neck or back pain
• Difficulty walking
• Balance problems
• Bowel or bladder dysfunction
• Autonomic symptoms
• Visual symptoms in some cases

For additional discussion of autonomic symptoms, see autonomic dysfunction and Lyme disease.

A diagnostically challenging case

The authors described a 23-year-old woman who was admitted with hand tremors and paresthesias extending into her forearms. She had slight weakness in her right arm and reported severe pain in the middle of her cervical spine.

For several months before hospitalization, she experienced nausea and vertigo.

She also experienced transient episodes of double vision when looking at distant objects and had a brief febrile illness several months earlier. She did not recall a tick bite.

The presentation was diagnostically challenging because her symptoms evolved gradually and several months elapsed between symptom onset and hospitalization.

Testing supported Lyme neuroborreliosis and spinal cord involvement

Examination revealed bilateral papilloedema and diffuse thickening of the retinal nerve fiber layer.

Additional findings included:

• Flame-like peripapillary hemorrhages
• Peripheral neuropathy findings on nerve conduction studies
• Radiculopathy involving multiple nerve roots
• Normal routine blood tests
• Positive Lyme antibody testing in serum
• Lymphocytic pleocytosis and elevated protein in cerebrospinal fluid
• Intrathecal production of antibodies against Borrelia burgdorferi

MRI demonstrated longitudinal enlargement of the spinal cord, most visible from C3 through C6/C7. A central lesion extended from C1 through C6/C7.

Imaging of the optic nerves revealed findings that suggested elevated intracranial pressure. However, cerebrospinal fluid opening pressure was not documented. The authors cautioned that papilloedema should not be treated as definitive evidence of Lyme neuroborreliosis by itself.

For additional discussion of visual complications, see ocular Lyme disease.

Lyme neuroborreliosis and subacute transverse myelitis

Cerebrospinal fluid testing showed lymphocytic pleocytosis, increased protein, antibodies against Borrelia burgdorferi, and an elevated antibody index indicating intrathecal antibody production.

The patient met European criteria for definite Lyme neuroborreliosis and was diagnosed with subacute transverse myelitis associated with neuroborreliosis.

She was treated with a 28-day course of intravenous ceftriaxone.

Her symptoms subsided, cerebrospinal fluid abnormalities normalized, and follow-up MRI showed resolution of the spinal cord lesion and meningeal enhancement. A minor hand tremor resolved one month later.

Although the patient experienced clinical recovery, subsequent ophthalmologic follow-up showed areas of retinal nerve fiber layer atrophy. This distinction is important when describing the outcome as a complete recovery.

According to the authors, the patient demonstrated features of subacute transverse myelitis along with papilloedema and other optic findings—an uncommon and diagnostically challenging combination.

Why diagnosis may be difficult

Lyme-associated transverse myelitis may be overlooked because its symptoms overlap with multiple sclerosis, neuromyelitis optica spectrum disorder, autoimmune disease, infectious myelitis, vascular disorders, structural spinal cord compression, and other neurologic conditions.

Patients may not recall a tick bite, rash, or early symptoms of Lyme disease.

Neurologic presentations involving spinal cord inflammation often require simultaneous evaluation for infectious, inflammatory, autoimmune, vascular, and structural causes.

Frequently Asked Questions

These are common questions about Lyme disease and transverse myelitis.

Can Lyme disease cause transverse myelitis?

Yes. Lyme disease can rarely be associated with transverse myelitis, particularly when Lyme neuroborreliosis involves the spinal cord.

Can Lyme disease cause spinal stenosis?

Lyme disease is not recognized as a cause of structural spinal stenosis. However, Lyme neuroborreliosis can rarely cause inflammation or lesions within the spinal cord that may produce overlapping neurologic symptoms.

Can Lyme disease cause lesions on the spine?

Lyme neuroborreliosis may rarely be associated with inflammatory lesions within the spinal cord or abnormalities visible on spinal MRI. These inflammatory lesions are different from structural or degenerative spine disease.

What symptoms suggest spinal cord involvement in Lyme disease?

Weakness, sensory loss, gait abnormalities, abnormal reflexes, and bowel or bladder dysfunction may suggest spinal cord involvement. New or rapidly worsening neurologic symptoms require prompt medical evaluation.

Can Lyme disease affect vision along with spinal cord symptoms?

Yes. Rare cases of neuroborreliosis have included papilloedema, double vision, optic nerve abnormalities, or other visual symptoms alongside spinal cord findings. These findings require evaluation for other neurologic and ophthalmologic causes as well.

What is transverse myelitis?

Transverse myelitis is inflammation within the spinal cord that may lead to weakness, sensory changes, pain, gait difficulties, and autonomic dysfunction.

Clinical Takeaway

Subacute transverse myelitis is an uncommon but recognized neurologic manifestation associated with Lyme neuroborreliosis.

Patients with weakness, sensory changes, gait abnormalities, spinal cord lesions, autonomic dysfunction, or other unexplained neurologic symptoms may require evaluation for infectious, inflammatory, autoimmune, vascular, and structural causes.

Because Lyme disease may rarely involve the spinal cord while producing visual or optic findings, atypical neurologic presentations deserve careful consideration, particularly in Lyme-endemic regions.

Related Articles

Lyme disease manifesting as acute transverse myelitis

Lyme disease causes acute transverse myelitis in a 25-year-old man

Neurologic Lyme disease

Ocular Lyme disease

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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