Lyme disease causes “false brain tumor” in young child

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this episode, I’ll be discussing a case involving a 9-year-old boy with with a pseudotumor cerebri  involving the brain due to Lyme disease.

Ezequiel and colleagues first described this case in the British Medical Journal Case Reports in 2017.¹

Pseudotumor cerebri means “false brain tumor” because its symptoms are similar to those caused by brain tumors. It’s also known as idiopathic intracranial hypertension.

Symptoms mimic brain tumor 

The boy was admitted to the hospital with “daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia, without night awakening, vomiting or visual changes,” the authors write. (Photophobia is sensitivity to light. Phonophobia is fear or aversion to sound.)

The doctors found papilloedema, which is swelling of the optic disc but no neck pain. A CT scan of the patient’s head was normal. He had an increased opening pressure in his spinal tap. In other words, the fluid removed from his spinal tap was under higher pressure.

Pseudotumor cerebri is a condition caused by elevated cerebrospinal fluid pressure in the brain.

The boy was diagnosed with a pseudotumor. Pseudotumor cerebri is a condition caused by elevated cerebrospinal fluid pressure in the brain. Symptoms can mimic a brain tumor, but in fact are due to intracranial pressure in the head.

He was prescribed acetazolamide while undergoing further evaluation. (Acetazolamide is a diuretic and carbonic anhydrase inhibitor medication that is used to reduce eye pressure.)

The boy was tested for a wide range of bacterial and viral infections, all of which were negative.

Treatment for neuroborreliosis 

He lived in Portugal and because he had visited the countryside prior to developing symptoms, he was tested for Lyme disease. A Western blot and spinal tap revealed he was positive.

The boy was diagnosed with Lyme disease  involving his brain and treated with a 21-day course of intravenous ceftriaxone. He recovered completely.

The authors point out, “CSF [cerebral spinal fluid] changes are not common, so in their presence, it is compulsory to investigate an infectious origin, as happened in this case, as the intracranial hypertension might be the only symptom of a central nervous system infection.”

Furthermore, “Borrelia infections should be actively investigated in children with central nervous system disease even in non-endemic areas.”

The following questions are addressed in this Podcast:

1. What is Pseudotumor cerebri and why is it referred to as ‘false brain tumor?’
2. What are the causes and how is it diagnosed?
3. How often does pseudotumor cerebri occur in Lyme disease?
4. Can it be the only manifestation of Lyme disease?
5. Can you discuss the boy’s initial treatment?
6. What are your thoughts on the treatment he received for Lyme disease?

Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.