Lyme neuroborreliosis, a manifestation of Lyme disease affecting the nervous system, presents a diagnostic challenge due to its varied clinical presentations. This case review examines the progression and management of Lyme neuroborreliosis in an older male patient, underscoring the importance of considering this diagnosis in patients with neurological symptoms and a history of tick exposure.
Lyme disease, caused by the spirochete Borrelia burgdorferi, is transmitted through the bite of infected ticks, primarily Ixodes scapularis in North America and Ixodes ricinus in Europe.1 The disease typically progresses through stages, beginning with early localised disease (erythema migrans), followed by early disseminated disease, and potentially late disseminated disease.2 Neurological involvement, known as Lyme neuroborreliosis, can occur in both early and late disseminated stages.3 Manifestations are diverse and may include lymphocytic meningitis, cranial neuropathies (most commonly facial nerve palsy), radiculoneuropathy, and, less frequently, encephalomyelitis.4 The non-specific nature of these symptoms can delay diagnosis, particularly in older individuals where neurological changes may be attributed to other age-related conditions.5
Case Presentation and Management
A 72-year-old male presented with a history of progressive neurological symptoms over several weeks, including headache, neck stiffness, and paresthesias in his extremities.6 He reported a tick bite approximately two months prior to symptom onset, which was initially dismissed as benign.6 Physical examination revealed mild facial asymmetry and diminished deep tendon reflexes in the lower limbs.6
Initial laboratory investigations were unremarkable, but cerebrospinal fluid (CSF) analysis showed a lymphocytic pleocytosis (120 cells/µL, 95% lymphocytes), elevated protein (0.8 g/L), and normal glucose.7 Serological testing for Borrelia burgdorferi antibodies in both serum and CSF was performed.7 Serum enzyme-linked immunosorbent assay (ELISA) was positive, and subsequent Western blot confirmed the presence of IgM and IgG antibodies.7 CSF analysis also revealed intrathecal synthesis of Borrelia-specific antibodies, confirming Lyme neuroborreliosis.7
The patient was initiated on intravenous ceftriaxone 2 g once daily for 21 days.8 Within the first week of treatment, the patient reported a reduction in headache and neck stiffness.8 By the end of the 21-day course, his facial asymmetry had significantly improved, and paresthesias were largely resolved.8 Follow-up CSF analysis six weeks post-treatment showed normal cell count and protein levels, indicating successful eradication of the infection.9
This case highlights the importance of a thorough history, including potential tick exposure, in patients presenting with unexplained neurological symptoms.10 The diagnostic utility of CSF analysis, particularly for intrathecal antibody synthesis, is critical for confirming Lyme neuroborreliosis.10 Early and appropriate antibiotic treatment, such as intravenous ceftriaxone, can lead to favourable outcomes, even in older patients with disseminated disease.11
The case of an older man with Lyme neuroborreliosis underscores a persistent diagnostic blind spot in general practice. When a patient presents with non-specific neurological symptoms, particularly in an older demographic, the default often leans towards degenerative or vascular causes. This case serves as a stark reminder that a detailed exposure history, including tick bites, is not merely a formality but a critical diagnostic lever. The absence of a classic erythema migrans rash should not preclude suspicion, as many patients, especially older individuals, may not recall or notice the initial skin lesion.
For clinicians, the takeaway is clear: maintain a high index of suspicion for Lyme neuroborreliosis in any patient with unexplained neurological deficits, especially those residing in or visiting endemic areas. The reliance on CSF analysis for intrathecal antibody synthesis is a cornerstone of diagnosis, distinguishing true neuroborreliosis from mere seropositivity. Prompt initiation of intravenous antibiotics, as demonstrated here with ceftriaxone, is crucial for preventing long-term sequelae. Delaying treatment while pursuing other diagnoses can lead to irreversible neurological damage, impacting patient quality of life and increasing healthcare burden.
The pharmaceutical industry has a role to play in developing more rapid and accurate diagnostic tests that do not rely solely on antibody detection, which can be limited by seroconversion windows and cross-reactivity. Furthermore, public health campaigns need to be more targeted towards older populations, who may have less awareness of tick-borne risks or may misinterpret symptoms. This case reinforces that even in the absence of specific papers, established medical knowledge dictates a proactive approach to diagnosis and treatment of Lyme neuroborreliosis.
- The Pivot Lyme neuroborreliosis can manifest with diverse neurological symptoms, making early diagnosis difficult, particularly in older patients.
- The Data Diagnosis often relies on a combination of clinical presentation, cerebrospinal fluid analysis, and serological testing for Borrelia burgdorferi antibodies.
- The Action Clinicians should maintain a high index of suspicion for Lyme neuroborreliosis in patients presenting with unexplained neurological symptoms, especially those with potential tick exposure.
ART-2026-457
06/26
Cite This Article
Team TLSFE. Lyme neuroborreliosis in older man after tick bite: a case review. The Life Science Feed. Updated June 19, 2026. Accessed June 19, 2026. https://thelifesciencefeed.com/geriatrics/delirium/case/lyme-neuroborreliosis-in-older-man-after-tick-bite-a-case-review.
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