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neuroborreliosis; Lyme Disease - Neurologic
see Lyme Disease
Clinical manifestations:
- lymphocytic meningitis
- radiculitis radiculoneuritis
- often multifocal, polyradiculitis, meningoradiculitis
- motor fibers & sensory fibers
- mononeuritis multiplex [2]
- 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
Special laboratory:
- lumbar puncture with CSF analysis for neuroborreliosis [1]
a) lymphocytic pleocytosis
b) elevated protein
c) oligoclonal immunoglobulins
d) may be normal
e) CSF/serum antibody index (ELISA not immunoblot) best method
f) CSF findings in Lyme meningitis indistinguishable from other forms of aseptic meningitis [1]
Radiology:
- CT of head (neuroimaging) unnecessary for suspected neuroborreliosis
- neuroborreliosis rarely associated with parenchymal brain lesions [1]
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 [1]
General
Lyme disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018
- Lantos PM et al.
Clinical Practice Guidelines by the Infectious Diseases Society of America
(IDSA), American Academy of Neurology (AAN), and American College of Rheumatology
(ACR): 2020 Guidelines for the prevention, diagnosis and treatment of Lyme Disease.
Clin Infect Dis 2020 Nov 30
http://fdslive.oup.com/www.oup.com/pdf/production_in_progress.pdf