Lyme borreliosis and cranial neuropathy

Abstract

In a 2-year study of 37 consecutive adult patients with isolated cranial nerve affection of primarily unknown origin, seen at a neurological clinic, borrelia infection was identified as the cause in six cases. Four patients had a peripheral facial palsy and two had a sixth nerve palsy. The patients with borreliosis had headaches or other pain considerably more often than patients with other or unknown aetiology. All six patients had accompanying symptoms and/or signs; in five cases these were obvious, and pointed to a borrelia infection. This study indicates that a careful history to elicit other symptoms of Lyme borreliosis will usually identify the cranial nerve affections with borrelial aetiology in adult patients. To verify the diagnosis, both serum and CSF analysis should be performed. Routine testing for borrelia serology in all patients with cranial neuropathy is generally not indicated.

Western Blot Analysis for Diagnosis of Lyme Disease in Acute Facial Palsy

“… 21,22 Furthermore, both serum and CSF analyses are advocated to verify the diagnosis of Lyme borreliosis in patients with Bell's palsy. 22 …”

“…Interestingly, some studies in Europe reported that all patients with Lyme facial palsy had additional clinical manifestations not present in patients with Bell's palsy. 21,22 Furthermore, both serum and CSF analyses are advocated to verify the diagnosis of Lyme borreliosis in patients with Bell's palsy. 22 IgM antibody appears early in Lyme disease and usually persists for a long time.…”

“…21,22 Furthermore, both serum and CSF analyses are advocated to verify the diagnosis of Lyme borreliosis in patients with Bell's palsy. 22 IgM antibody appears early in Lyme disease and usually persists for a long time. 4 In contrast, IgG antibody is often negative in the acute phase of the disease.…”

Adaptation ofBorrelia burgdorferiin the tick and the mammalian host

“…Even without treatment, the rash generally resolves within 3–4 weeks. However, the spirochete can be detected in the blood and if the patient is not treated, the disease can evolve into secondary and tertiary complications [6–19]. Secondary disease may be manifested by disseminated skin rashes, carditis, aseptic meningitis, or acute arthritis [7,16,20–22].…”

Third Nerve Palsies

“…Infectious and neoplastic seeding of the subarachnoid space can result in dysfunction of numerous cranial nerves, including the ocular motor nerves. [1][2][3]105,106,109,110,114,[255][256][257] Noninfectious inflammatory causes, such as neurosarcoidosis, Wegener's granulomatosis and Behçet's syndrome, have also been implicated. [1][2][3]258 Head trauma with presumed shearing of multiple cranial nerves, [1][2][3]99,119,123,153,259 base of the skull tumors, particularly along the clivus, [1][2][3][260][261][262][263][264][265][266][267][268][269][270][271][272][273][274][275][276][277][278] and possibly dolichoectatic vasculature 2 may also result in a picture of multiple cranial neuropathies.…”