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Cerebral Aneurysm in Lyme Neuroborreliosis with Regression After Medical Treatment

Jonathan Tiu, Richard M Hanson and Robert Staudinger

Lyme disease in the United States is caused predominantly by the spirochete Borrelia burgdorferi and affects multiple organ systems. Lyme Borreliosis infrequently involves the peripheral and central nervous system, and the term Neuroborreliosis is used for the latter case. The most common manifestations of Neuroborreliosis include cranial neuropathy and lymphocytic meningitis. It can also cause cerebral vasculitis leading to both wall thickening and endothelial obliteration. Other manifestations include stroke, with over 50 documented cases, and rarely nonaneurysmal subarachnoid hemorrhage and intraparenchymal hemorrhage.

Intracranial aneurysm detected in the setting of Lyme Borreliosis infection has been previously documented in four cases [3,4]. However, the existence of a causal relationship between Lyme infection and intracranial aneurysm has been debated. We discuss these cases, and present our own case of a man with Lyme Neuroborreliosis with an intracranial aneurysm which regressed upon completion of treatment with ceftriaxone.