When it looks like a brain tumor, but it is Lyme disease

Pseudotumor cerebri, also referred to as idiopathic intracranial hypertension, is a condition caused by elevated cerebrospinal fluid pressure in the brain. Symptoms can mimic a brain tumor, but in actuality there is no tumor. Instead, there is unexplained intracranial pressure in the head. The condition is rare in prepubertal children.


Ezequiel and colleagues report on the case of a 9-year-old boy from Portugal who was diagnosed with pseudotumor cerebri due to Lyme disease. The child “was admitted with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia, without night awakening, vomiting or visual changes,” writes Ezequiel in the British Medical Journal Case Reports. [1]

His neurological examination revealed papilloedema (swelling of the optic disc) but was otherwise normal. Brain images were unremarkable. Serologic, PCR and cultural testing ruled out bacterial and viral agents including Mycoplasma pneumoniae, Epstein-Barr virus, Cytomegalovirus and Enterovirus. So the boy was prescribed acetazolamide (a “water” pill).

Symptoms of a brain tumor turn out to be Lyme disease in 9-year-old boy. Click To Tweet

However, ELISA and Western blot results were positive for B. burgdorferi antibodies, the bacteria causing Lyme disease. “The diagnosis of neuroborreliosis was assumed,” explains Ezequiel “and a 21-day course of intravenous ceftriaxone was started.” The boy made a complete recovery.

According to Ezequiel, the boy met the clinical criteria for pseudotumor cerebri, which is defined as including “symptoms and signs isolated from those produced by increased intracranial pressure, such as headache, papilloedema, vision loss and elevated intracranial pressure with normal CSF composition.”

There are many causes of pseudotumor cerebri, Ezequiel explains, so the differential diagnosis is vast and includes “infectious diseases such as meningitis, otitis media and mastoiditis, obstruction of venous drainage such as venous sinus thrombosis and hyperviscosity, endocrine disorders, obesity, nutritional disorders such as hypervitaminosis A and medications.”

The authors highlight several key points:

• Pseudotumor cerebri can be the sole manifestation of neuroborreliosis.
• A history of tick bite is often absent in many cases.
• Central nervous system involvement can occur with no cutaneous manifestations.
• Borrelia infections should be actively investigated in children with central nervous system disease even in non-endemic areas.

Related Articles:

Child with Lyme disease presenting as pseudotumor cerebri

Case report: Neuroborreliosis more common in children

What happens to the brain during acute Lyme neuroborreliosis?



  1. Ezequiel M, Teixeira AT, Brito MJ, Luis C. Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area. BMJ Case Rep. 2018;2018.

22 Replies to "When it looks like a brain tumor, but it is Lyme disease"

  • Cora
    01/03/2022 (1:35 am)

    My husband has just gone through an intensive antibiotic treatment for chronic Lyme (confirmed by Igenix and C6 and antibody testing) as he was infected about 23 years ago. His fatigue and mental cognition appear to be improved but his major symptoms of diplopia & vertigo remain. Do you think this could be secondary to lyme causing a pseudo tumor cerebri? His brain mris in the past show no evidence of tumor but do have some areas of heightened lucency. We are unsure of what steps to take next. Thank you

    • Dr. Daniel Cameron
      01/03/2022 (8:25 am)

      I have found it can be just as difficult diagnosing pseudo tumor cerebri as Lyme disease for some of my patients. I have asked specialists to weigh in while I follow my patient. I have some patients who appeared to have an unresolved tick borne infection that was the cause of the symptoms.

  • Ron M
    07/07/2021 (10:48 pm)

    I just stumbled across this, Curious where to find help. i had an astrocytoma removed at mayo 7 years ago, 90% resected, now, i have a 5cm x 5cm brain cyst in same lobe and new tumor (maybe astrocytoma again). Im thinking there may be a link to lyme considering symptoms, cfs nose drip, ctreme head pressure, complete scalp an facial an oral, eye socket numbness and went thru stage 1/2 lyme symptoms but never was tested, now it all might make sense!
    I’m willing to fly in to office @ NY for a exam! ????
    Thx for any thoughts doc

    • Dr. Daniel Cameron
      07/08/2021 (12:13 pm)

      I typically advise my patients to follow-up their neurologis if the symptoms appear related to the astrocytoma and surgery. I have had patients who have Lyme disease along with their cancer that have benefited from treatment for Lyme disease.

  • Lisa
    04/01/2020 (4:39 pm)

    Dr Cameron
    I’ve had Lyme for 12 yrs…..still treating with a variety of herbs and disulfuram. My head pressure will feel horrible when I laugh or cough or am short of breath. I also have visual disturbances, occasionally. Do you recommend that I rule out a brain tumour?

    • Dr. Daniel Cameron
      04/01/2020 (6:37 pm)


      • gene boris
        04/24/2021 (8:05 pm)

        Hello Dr. Cameron…after having lyme disease symptoms for 23 years and having done the elisa and western blot tests TWICE…all showing negative. I know that this is not unusual to show negative test results after having lyme for decades..but what would you suggest to my doctor on getting other tests done? Cerebral spinal fluid tested? The intravenous ceftriazone might just be a solution for me like the boy in your article…as I too have head pressure with numerous other symptoms. But unless I can PROVE I have lyme disease..I will not be able to get that treatment. Thank you Gene

        • Dr. Daniel Cameron
          04/25/2021 (7:55 am)

          The labs can be disappointing. Nine out of ten individuals with chronic neurologic Lyme disease have a negative test. Your doctor will have to take a clinical judgement. You will also need to rule out other causes.

        • James Lewis
          04/29/2022 (9:31 pm)

          Hello Dr. Cameron,
          Was diagnosed with Lyme in Nov 2021 by Lyme panel and western blot under went antibiotic treatment thought I was getting better after 4 months starting having horrible insomnia, blurred vision ,night sweats , digestive problems, abdomen pain ,groin pain , terible anxiety ,80lbs of unintentional weight loss, went for tons of test labs , weird thing pop up but dismisses from my Drs.and hospital Got a endocanoligst he finds cortisol high,a cth. High
          R enin high andosterone low,testosterone low
          Did 24hr creatinine high ,cortisol 4x high value now scheduled for MRI next week for possible pituitary tumor ! My infectious disease Dr claims I’ve had enough antibiotics !! Says these are not symtoms of a continuous Lyme infection ..
          Can Lyme cause an increase in cortisol ?
          How does it effect the endocrine system ?
          Been suffering horribly can’t function wired 24 hours a day losing muscle mass and strength !!

          • Dr. Daniel Cameron
            05/03/2022 (7:58 am)

            I have not typically seen high cortisol levels in my patients. But I am not an endocrinologist. I lean on endocrinologist to rule out other illnesses.

  • Christine Flanagan
    03/12/2020 (5:50 am)

    Thank you all and especially you , Dr . Cameron for being empathetic and encouraging for us chronic Lyme sufferers,. As a registered nurse for 25 years in icu , and having been through the horrific Lyme symptoms, and having to fight and advocate for my own diagnosis and treatment you bring comfort and strength to myself and many going through a disease where people don’t understand or don’t believe you . I often get “well you don’t look sick “. Very horrible to be not validated .
    Thank you again

  • Brandon
    07/08/2019 (10:47 pm)

    This is a pretty fantastic article. My story can be found here:


    The punch line that isn’t included in the story is I was just diagnosed with Lyme disease a few months ago (rickettsia, ehrlichiosis, and babesia). Like the article, my intracranial pressure has been high since the beginning. I’m anxious to see how the headaches and pressure respond to treatment. Medicine needs more awareness with Lyme. It took 137 doctors before someone finally thought to look at a larger tick panel. Amazing.

  • AmyRose
    04/11/2019 (11:17 pm)

    I’m having much difficulty finding a doctor that will even test me for lyme and/or coinfections. I have all the symptoms and I am becoming quite debilitated. I have spent a lot of time outdoors my entire life and have always been around a lot of animals. About 4 years ago, I was walking through the woods with my boyfriend when suddenly I noticed my boyfriend was covered in tiny ticks I looked down and they were all over me too! We must’ve walked through a nest or something. It was awful. We brushed them off as fast as we could and we didn’t notice that any had latched on but I starting developing symptoms shortly after. More recently, I’ve been having pain in the occipital region on the right side and extreme fatigue. I’m a nursing student with not the greatest insurance and not a lot of money to fund treatment that’s not covered. I’m getting very discouraged and finding it difficult to meet even the most basic of life’s demands lately. I don’t know what to do anymore. I’m really scared.
    I’m so desperate, that I’m about to buy and take animal doxycycline. I know this is probably not the best idea but I’m at a loss here and I need to be able to function obviously. Ugh!
    Thanks for this information.

  • shareen
    11/07/2018 (12:27 pm)

    Dr. Cameron,
    Last year my 10 year old daughter was on our 65 acres of land in Georgia and got multiple nympth tick bites, rash and 6 weeks later full blown symptoms. We went to an ILADS director ..Barnwell, who did 9 months of cefdinir and azithromycin, She wanted to use mepron as well to cover babesia but my husband and I thought that was too much on her so we skipped the mepron.SHe stopped the cef/azith 4 months ago and since then is getting a progression of daily headaches..usually in the afternoon and top of head with eye pain. Mri was clear as well as eye exam.Infectious Dr we went to said there is No Lyme in Ga!! the other night she got a 101 fever and flu symptoms which left the next morning. We moved from Ga 4 months ago to escape the tick epidemic and are on the gulf coast.. wth no drs here to help us. SIerra also developed scoliosis 6 months ago.. what of her symptoms could be lyme or co infections and what does it sound like she has??

    • Dr. Daniel Cameron
      11/07/2018 (1:54 pm)

      I am sorry to hear your daughter remains ill. Your story reflects the difficulties finding an answer. It remains important to see differing specialists until you find an answer.

  • Jennie
    10/30/2018 (9:18 pm)

    Doctor, last year I had a brain/pituitary MRI with contrast and the report said I had a 3mm pituitary adenoma. After traveling to top
    endocrine center, USC , Cedars Sinai , UCLA and St Johns Provident I received all differing opinions from the Drs. and Neurosurgeon Drs..
    The first 2 said it was a RAnthkes Cleft cyst, UCLA Neurosurgeon said there were no characteristics to lead him to believe it was either an adenoma or cyst. St. John Neurosurgeon said it was nothing and should be re tested each year for growth. I was just diagnosed with Lyme disease and Im wondering is this 3 mm dark circle a false tumor of some sort??

    • Dr. Daniel Cameron
      10/31/2018 (7:21 am)

      I will often find something during my Lyme disease evaluation. I ask my consultants to evaluate each finding. I am not sure the lesion you described is related. I hope treatment for Lyme disease helps,

  • Gladys
    10/10/2018 (11:08 pm)

    Same symptoms here! I was diagnosed with Lyme disease but my headaches are just terrible I need to stay in bed at least 3 days. It seems like I will have it for the rest of my life. 🙁

    • Dr. Daniel Cameron
      10/11/2018 (12:18 am)

      It can be discouraging. Keep working on finding an answer.

  • Christy Colasurdo
    05/25/2018 (12:56 am)

    I an adult female was diagnosed with Lyme disease about six years ago, and have a persistent daily headache/feeling like brain is swollen/ intracranial pressure, as well as vision loss. Localized nerve blocs helped the head pain (but one can only do these sparingly) and about 9 months of intramuscular Bicillin injections helped mitigate (but not eliminate) some of the more debilitating other Lyme symptoms, like migrating joint pain, stiff neck, inability to retrieve common words (loss of cognition for a time). In your experience, is there evidence that Lyme affects the occipital nerve?

    • Dr. Daniel Cameron
      05/27/2018 (1:06 pm)

      You are not alone. There are a number of Lyme disease patients with pain in the occipital area. It sounds as if antibiotics and blocs have helped but not eliminated your pain.

    • Maureen
      10/31/2018 (6:34 pm)

      My situation is exactly like yours! I have Lyme disease and daily headaches. I also have double vision for which I now wear prism glasses. I have tried occipital nerve blocs, botox, and many headache medicines, with little results for the migraines. Yesterday, I had an MRI which indicates Lyme disease in my brain as well as other issues. I see my Neurologist tomorrow. It is very frightening

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