Neuroborreliosis can cause a wide variety of seemingly unrelated neurologic abnormalities. Although the epidemiology, etiology, and pathology of this infection have been well documented, the pathogenesis and diagnosis continue to be problematic. In the current study we report a case of Lyme disease in which subarachnoid hemorrhage was the presenting feature of a patient with polyradiculoneuropathy and encephalopathy. Magnetic resonance imaging of the spine demonstrated diffuse pial and meningeal enhancement with more focal nodular areas of involvement.