Ischemic Stroke With Hemorrhagic Conversion in a Case of Lyme Neuroborreliosis

Lyme disease is an infectious tick-borne illness predominant in northeastern and midwestern United States. The clinical presentation varies significantly and only a few cases develop Lyme neuroborreliosis (LNB), which makes diagnosis difficult. A 59-year-old male visiting from Michigan presented to a hospital in Florida with an ischemic stroke with aphasia and acute confusion for two days. He had imaging that noted a subacute infarct in the left parietal lobe along with multiple areas of white matter signal abnormalities and CSF serology positive for Borrelia burgdorferi IgM and IgG antibodies. The patient was placed on ceftriaxone for 30 days and showed significant clinical improvement. We present a case of ischemic stroke with hemorrhagic conversion and an incidental finding of LNB.