neuroborreliosis; Lyme Disease - Neurologic

Introduction

see Lyme Disease

Clinical manifestations

• lymphocytic meningitis
• radiculitis radiculoneuritis
  • often multifocal, polyradiculitis, meningoradiculitis
  • motor fibers & sensory fibers
• mononeuritis multiplex
• cranial neuritis (image)
  • most commonly facial (CN VII) palsy (Bell's palsy)
  • bilateral CN VII palsy in an endemic area is diagnostic
• confused speech, somnolence, & visual impairment noted with Borrelia mayonii

Diagnostic procedures

• lumbar puncture with CSF analysis for neuroborreliosis
  • lymphocytic pleocytosis
  • elevated protein
  • oligoclonal immunoglobulins
  • may be normal
  • CSF/serum antibody index (ELISA not immunoblot) best method
  • CSF findings in Lyme meningitis indistinguishable from other forms of aseptic meningitis

Radiology

• CT of head (neuroimaging) unnecessary for suspected neuroborreliosis
  • neuroborreliosis rarely associated with parenchymal brain lesions

Complications

• patients with Lyme neuroborreliosis have increased risks for hematological cancer & skin cancers, otherwise similar long-term health outcomes to their unaffected peers

Management

• ceftriaxone 2 g IV QD for 14 days (1st line)
• alternative agents
  • Penicillin G 20 million units IV QD for 14 days
  • cefotaxime 2 g IV every 8 hours

More general terms

• Lyme disease