A Swiss teen who arrived an emergency room with seemingly classic symptoms of stroke ended up diagnosed with Lyme disease. The details of this case were published in the Annals of Emergency Medicine in late February.

"Everything about her symptoms indicated stroke: speech deficits, poor comprehension and right-sided face and arm weakness, so we considered treating her with clot-busting drugs," said lead author Dr. Arseny Sokolov of the Department of Clinical Neuroscience, Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland. "But a 16 year-old having a stroke, while not unheard of, would be quite rare so we looked at other possibilities and found Lyme."

The female presented to the emergency room with sudden-onset aphasia and transient right-sided faciobrachial hemiplegia, along with headache and agitation.

Brain imaging ruled out ischemia, vasculitis or another structural lesion. Toxicology results were negative. Cerebral perfusion computed tomography and electroencephalography showed left parietotemporal brain dysfunction.

Lumbar puncture result, although atypical, suggested bacterial infection, and intravenous ceftriaxone was initiated. After the drug was started, her condition improved immediately.

Doctors ultimately discovered 16-year-old's condition via spinal tap, which showed elevated white blood cell count and Lyme neuroborrecliosis.

"The imaging findings for the first time demonstrate acute brain dysfunction that appears to be directly related to neuroborreliosis," said senior co-author Renaud Du Pasquier, M.D., neurology chairman at the Centre Hospitalier Universitaire Vaudois in Lausanne. "It may point out future perspectives for research on the underlying mechanisms."

Lyme disease is known as “the great imitator,” as its symptoms can mimic so many other diseases. This case is not the first where a patient was ultimately diagnosed with Lyme disease first presented with symptoms of other conditions, including stroke, ALS, Alzheimer's disease, epilepsy, multiple sclerosis, fibromyalgia, chronic fatigue and anxiety. Because the disease can appear like many others, a diagnosis is often difficult to reach.

"The uncommon set of symptoms our patient had show why Lyme is a 'chameleon disease' of the emergency department," Sokolov said. "Furthermore, the patient had no history of tick bite. This curious case just shows the careful detective work that is involved in such a large portion of emergency medicine."