tick in test tube

What Is Neurologic Lyme Disease?

Lyme disease isn’t a simple bacterial infection. The bacterium that causes the disease, Borrelia, can infiltrate the body in many ways, leaving patients to cope with and recover from widespread health issues and, in some cases, permanent damage to bodily systems, including the neurological system. When Lyme disease infiltrates the brain in this way, it is defined as neurologic Lyme disease. But what is neurologic Lyme disease, exactly? And how does it compromise your overall health? Read on to learn more.

What is neurologic Lyme disease?

Neurologic Lyme disease, or Lyme neuroborreliosis (LNB), occurs when the bacteria that causes Lyme disease goes through the body and into the central and peripheral nervous systems through the blood–brain barrier. Typically, a person who develops neurological Lyme disease symptoms will first experience the typical signs of infection before neurological involvement, such as a bulls-eye-shaped rash, flu-like symptoms, and head and joint aches.

If Lyme disease isn’t treated promptly following the onset of those symptoms, it will progress further, attacking other areas of the body, including the neurological system.

How do you get neurological Lyme disease?

Neurological Lyme disease occurs after a person becomes infected with the Borrelia bacteria. The spread of the infection occurs through tick bites, mainly from the deer tick, black-legged tick, or bear tick. These disease-harboring arachnids latch onto their host by biting and burrowing into their skin to feed on their blood.

Bacteria can be transferred from the tick into the bloodstream of whatever or whomever the tick is feeding on. While ticks tend to choose animal hosts, many humans have been caught in the mix when out in wooded areas. It takes 36 or more hours for a tick to spread the bacteria to a human, so they must feed for close to two days before finding the tick for you to be at risk of Lyme disease.

Once the infection is in the body, it can quickly turn into neurological Lyme disease if you are unaware that a possibly infected tick has bitten you and don’t seek treatment. It’s easy to confuse the classic symptoms of Lyme disease with other ailments, such as the common cold or flu.

tick on flower
Image by Erik Karits on Unsplash: How do you know if you have neurological Lyme disease?

What are the most common Lyme neuroborreliosis symptoms?

Lyme neuroborreliosis has many signs and symptoms, but they are often non-specific. Because of the general nature of the symptoms, neurological Lyme disease can often be mistaken for various other health disorders that present in the same way.

Five distinct inflammatory conditions can develop because of Lyme neuroborreliosis, each with its own symptoms. These are:

Lymphocytic meningitis

This form of meningitis develops when the Lyme bacteria infiltrate the lymphatic system, a part of the body that helps filter out pathogens and waste. The membrane surrounding the brain and spinal cord, known as the meninges, becomes inflamed and swollen, leading to symptoms such as:

  • Extreme sensitivity to light
  • Stiff neck
  • Partial vision loss
  • Fever
  • Headache

Cranial neuritis

Cranial neuritis is a condition marked by inflammation of the nerves that control almost everything, including vision, balance, facial expression, movement, hearing, smell, and more. These nerves are referred to as cranial nerves, and they start at the brain stem. When someone develops cranial neuritis caused by Lyme disease, they can experience symptoms such as:

  • Facial palsy
  • Impairment in facial movements, such as blinking or smiling
  • Double vision
  • Difficulty or impairment in chewing


When the spinal nerve roots become inflamed, it is called radiculopathy. These nerves are assigned the task of sending signals from the brain to nerves that help with motor skills in the torso and limbs. There are several symptoms associated with Lyme-induced radiculopathy, including:

  • Numbness in the extremities
  • Muscle weakness
  • A burning, prickling, or tingling sensation in the limbs or body
  • Chronic pain that can move throughout the body

Mononeuritis multiplex

Mononeuritis multiplex develops when peripheral nerves become inflamed due to a Lyme bacterial infection. There are several symptoms associated with the condition, including:

  • Weakness that can be extreme at times
  • Numbness in the hands and feet
  • Chronic pain
  • Pain in the hip, lower back, or leg that worsens at night

Lyme-induced encephalitis and myelitis

In some cases, Lyme encephalitis or myelitis – brain and spinal cord inflammation – can occur. Symptoms include:

  • Confusion
  • Speech impairments
  • Changes in how you walk
  • Rapid eye movements 

The symptoms a person with Lyme neuroborreliosis experiences will differ depending on what part of the nervous system is affected.

tick on leaf
Image by Erik Karits on Unsplash: Is it hard to get a neuroborreliosis diagnosis?

How is Lyme neuroborreliosis diagnosed?

Doctors will perform blood tests and exams to diagnose Lyme neuroborreliosis properly. This is because the symptoms experienced in neurological Lyme disease are similar to many other disorders. Typically, blood tests are done first to check for signs of the bacteria. Tests include: 

  • Enzyme-linked immunoassays (ELI) to check for antibodies made in response to the infection.
  • Western blot tests to check for further signs of infection if the ELI test comes back positive.

Because neurological Lyme disease presents so similarly to other conditions, a process of elimination may also be performed using various tests to rule out conditions such as:

  • Alzheimer’s disease
  • Brain tumors
  • Chronic fatigue syndrome
  • Guillain-Barré syndrome
  • Lupus
  • MS
  • Neurosyphilis
  • Sarcoidosis

What is the best Lyme neuroborreliosis treatment?

Neurological Lyme disease must be treated using antibiotics because it is a bacterial infection. The primary antibiotics used are:

  • Penicillin
  • Ceftriaxone
  • Cefotaxime
  • Doxycycline (only for those over eight years of age)

Because Lyme disease can evade detection by the immune system and camp out in tissues and cells, it is notoriously difficult to treat, even using these antibiotics. This is why they are often given intravenously. These medications must make it through the blood–brain barrier to make a difference in neurological Lyme disease. To do so, they have to be injected directly into the bloodstream.

Lyme neuroborreliosis is a challenging and harmful secondary presentation of Lyme disease, and it’s crucial to ensure that you avoid it at all costs by always staying covered in areas where ticks live, removing any ticks you find as quickly as possible, and seeking treatment for Lyme disease as soon as you notice symptoms. 

Featured image by Marino Linic on Unsplash

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