Lyme neuroborreliosis

Last edited 05/2020

• 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

Reference:

• (1) Centers for Disease Control and Prevention. Lyme Disease (accessed 29/5/2020)
• (2) Bratton R.L. et al. Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008;83(5):566-71
• (3) Kullber BJ et al. Lyme borreliosis: diagnosis and management.BMJ 2020;369:m1041