Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area

Abstract

Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm HO) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.

Papilledema as the Sole Manifestation of Neuroborreliosis

“…A 16-year-old male was treated for Lyme disease with antibiotics after presenting with arthritis of the left knee, and six months later, he developed blurred vision of the left eye and was found to have unilateral optic neuritis with positive Lyme serology. A 13-year-old female presented with headache, nausea, and low-grade fever, and three weeks later, she developed Ezequiel et al [7] reported a case of a 9-year-old male who presented with headache, phonophobia, and photophobia but no visual changes. He was found to have bilateral papilledema on exam and an elevated opening pressure during lumbar puncture.…”

“…Ezequiel et al [ 7 ] reported a case of a 9-year-old male who presented with headache, phonophobia, and photophobia but no visual changes. He was found to have bilateral papilledema on exam and an elevated opening pressure during lumbar puncture.…”

“…The most common neurologic manifestation in children is headache followed by facial nerve palsy [ 5 ]. Subacute lymphocytic meningitis is also frequently described [ 7 ]. Meningitis, intracranial hypertension, and papilledema occur more commonly in children than adults [ 8 ].…”

A Practical Approach to the Diagnosis of Lyme Borreliosis: From Clinical Heterogeneity to Laboratory Methods

“…Pseudo tumor cerebri associated with LB was first described in 1985 (67). Subsequently, other cases have been described mainly in children (68) and rarely in adults (69). Infection of the central nervous system is observed in 2-4% of Lyme neuroborreliosis, typically in the late or chronic stage of the disease (70).…”

“…Pseudo tumor cerebri associated with LB was first described in 1985 ( 67 ). Subsequently, other cases have been described mainly in children ( 68 ) and rarely in adults ( 69 ).…”