Lyme Meningoencephalitis Masquerading as Normal Pressure Hydrocephalus

Monitoring Editor: Alexander Muacevic and John R Adler
Aakash Desai, Gaurav Manek, Anand M Krishnan, Corina Iorgoveanu, Ahmed Zaghloul

Lyme disease is a tick-borne illness caused primarily by the spirochete Borrelia burgdorferi. The disease is most prevalent in forested areas endemic for Ixodes tick, which transmits the spirochete. Here, we describe a case of Lyme meningoencephalitis masquerading as normal pressure hydrocephalus (NPH) which initially presented with urinary incontinence, gait instability, and neurological decline. Due to its non-specific symptoms and low incidence, Lyme meningoencephalitis causing NPH like syndrome poses a diagnostic conundrum for clinicians. Awareness of this disease entity is key for prompt diagnosis and treatment.



Normal Pressure Hydrocephalus (NPH), which normally affects older people, is a brain disorder where there’s too much cerebrospinal fluid in the brain’s ventricle which causes trouble reasoning, thinking and walking, as well as loss of bladder control.  There can also be personality & behavior changes, and apathy.  Brain imaging to detect enlarged ventricles as well as MRI’s help with diagnosis.  Causes include hemorrhages, inflammation, and infections, and unknown reasons.

In this case, the patient appeared to have NPH but was rather infected with Lyme.

I know many patients who have excruciating headaches that they would describe as meningal, including myself.  The entire lining of the head hurts.  Some even receive a Chiari diagnosis as the swelling can force the brain to go through the opening of the skull.  For me the best antibiotics were those like minocycline which cross the blood/brain barrier.  I honestly wondered if I’d ever have a day without this head pain.  Good, effective treatment eradicated this but doctors are woefully unprepared.  Please contact your local Lyme support group if you have symptoms for a list of ILADS trained doctors who understand the complexity of this disease and will treat accordingly.

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