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).
[bctt tweet=”Symptoms of a brain tumor turn out to be Lyme disease in 9-year-old boy. ” username=”DrDanielCameron”]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?
References:
- 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.
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)
Certainly.
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 !!
Thanks,
James
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:
https://www.hormonesmatter.com/vasectomy-intracranial-hypertension-vision-balance-disturbances/
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.
teddi
10/28/2023 (3:40 pm)
I just read your article. Wish I had seen it sooner. I’ve been suffering constant headpain 13 yrs. Lyme and Babesia Positive. IIH has just entered my radar in the last couple of weeks. I’m waiting to get evaluated. Primary doc agrees I probably have it but didn’t know what to do with me. We’re kinda on our own out here trying to find answers and it’s awful. I’ve was diagnosed Lyme in 1990. I hope you are doing better, what a story! Too many of us suffering needlessly. Thank you Dr. Cameron for your article, wish I had seen it earlier too.
Dr. Daniel Cameron
10/29/2023 (8:48 am)
I hope you find treatment helpful.