(752) Brain Bug: When Lyme Disease Goes Rogue With a Subarachnoid Hemorrhage

Introduction: Lyme disease, caused by Borrelia burgdorferi infection, is prevalent in Europe and North America, progressing through three stages: early localized, early disseminated, and late disease. Neurological involvement, termed Lyme neuroborreliosis, intensifies with disease advancement, often presenting as lymphocytic meningoradiculitis. Rare instances may lead to diverse cerebrovascular complications. This case report explores an unusual manifestation: Lyme disease linked to subarachnoid hemorrhage (SAH).

Description: A 61-year-old female, with a medical history including left breast cancer in remission, paroxysmal supraventricular tachycardia, past Lyme disease, complete heart block status post permanent pacemaker insertion, and tobacco abuse, presented with progressively worsening headaches and transient dysphagia. Recent tick exposure prompted doxycycline therapy. CT scan revealed bilateral frontal lobe subarachnoid hemorrhage. Management included acetaminophen, dexamethasone, and neurosurgical consultation. Interventions included strict blood pressure under 140 mmHg, nimodipine, levetiracetam. Negative urinary toxicology and unremarkable DSA findings suggested Lyme-associated vascular damage. Lumbar puncture was unfortunately unsuccessful. The patient was discharged with outpatient neurology follow-up.

Discussion: Lyme disease progresses through stages, with neurological involvement increasing over time. While meningitis, neuropathy, or encephalomyelitis are common neurological abnormalities, rare cases including subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke, have been reported in the literature. Rare complications like SAH underscore the need for vigilant diagnosis, ruling out other more common alternative causes. Diagnostic tools like imaging and DSA aid in accurate assessment. In our case, a history of Lyme disease, recent tick exposure, and exclusion of other causes strongly supported Lyme-associated vascular damage. Despite challenges, this case highlights the importance of recognizing rare Lyme disease manifestations, necessitating a comprehensive diagnostic approach. This emphasizes the need for further research and awareness to fully understand Lyme disease's neurological spectrum, enabling timely intervention.