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Lyme neuroborreliosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • approximately 15% get neurological manifestations (neuroborreliosis), which usually occur within four weeks of the initial illness and resolve over 3 months. It is the most common complication of lyme disease in UK and may include (1,2):
    • meningoradiculoneuritis (Bannwarth's syndrome)
    • meningitis
    • cranial neuritis - usually VII, with palsy - very hard to distinguish from Bell's palsy
      • may be bilateral in up to 25% of individuals (3)
      • neuroborreliosis in children commonly manifests as facial nerve palsy, in contrast to adults who typically present with radiculoneuritis and lymphocytic CSF leocytosis (3)
      • Lyme radiculitis may present with signs resembling disc herniation
    • radicular neuritis (radiculoneuritis)
      • Lyme radiculitis may present with signs resembling disc herniation
        • pain is neuropathic, and dermatomal in distribution, while sensory defects and paresis may occur
    • parenchymal brain involvement is extremely rare
      • sporadic cases of chronic encephalitis or encephalomyelitis owing to Lyme borreliosis have been reported
      • cerebrovascular events resulting from CNS vasculitis have been associated with Lyme borreliosis, based on brain biopsy or intrathecal synthesis of anti-Borrelia antibodies, responding to antibiotic therapy

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