Man with Lyme disease and stroke. An Inside Lyme podcast.

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. I will be discussing an 83-year-old-man with Lyme disease and stroke in this Inside Lyme podcast.

Legast and her colleague first discussed this case in the journal Neurological Medicine  in 2018.

An 83-year-old man was hospitalized for right-sided weakness and speech difficulties. His brain CAT scan and MRI showed an ischemic stroke in the left corona radiate region.

An ischemic stroke is caused by a block or plug of a blood vessel in the brain. A corona radiata stroke is also called a ‘lacunar stroke’ or a ‘small vessel stroke’ because the region receives blood supply from small branches of the arteries in the brain. The block or plug is typically from the heart or neck.

There was also a small left parietal lesion. The parietal lobe is vital for the sensory system, including the management of hearing, sight, touch, taste, and smell.

The doctors could not prescribe clot-dissolving medicine as the stroke developed over 24 hours.

There was no evidence of common causes of ischemic strokes, including hypertension, large vessel disease, or a cardiac source.

The man was positive for a lupus anticoagulant. Lupus anticoagulant can be seen in infectious and autoimmune diseases. The authors noted that antiphospholipid antibodies have been reported in a variety of illnesses, including ‘chronic Lyme disease.’

Lyme disease and stroke

In hindsight, the man recalled multiple tick bites over several years without a rash. Two years earlier, he had tingling in his hands and feet for four months.

The doctors included a Lyme disease test in their evaluation. The man tested positive for Lyme disease by ELISA and western blot testing.

[bctt tweet=”Lyme disease can lead to a stroke, albeit rare.” username=”DrDanielCameron”]

His spinal tap was positive for Lyme disease. The antibodies in his spinal fluid were more than 27 times higher than antibodies in his blood. The protein level in his spinal fluid was also high.

He was diagnosed with probable Lyme disease.

He was treated with intravenous ceftriaxone for 14 days.

He was able to walk with a cane but still had a severe right arm weakness. His antiphospholipid antibodies were negative after six weeks.

There have been strokes associated with Lyme disease, but the numbers of reported cases are rare and mainly in Europe, according to the authors.

The authors advised that Lyme disease be considered in patients living in an endemic area, with a history of Lyme disease, in the absence of another cause, and the presence of specific strokes. The authors listed two specific strokes, multiterritorial strokes, or vasculitis. This man had a stroke in two locations.

What can we learn from these cases?

1. Lyme disease and stroke can be associated, albeit rare.

What questions does these cases raise?

1. How often are Lyme disease and stroke associated?
2. Could treatment for Lyme disease prevent a stroke?
3. Would the man’s right-sided weakness have improved if the man had been treated with more than two weeks of antibiotics?

Treating Tick-Borne Disease In My Practice

In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills recognizing Lyme disease and stroke. We hope that professionals evaluating individuals with a Lyme disease and stroke can use this case to remind them to look for tick-borne illnesses and treat accordingly.