Neurology · MU Sofia

51. Lyme disease

Covers Lyme disease, a tick-borne infection caused by Borrelia burgdorferi and its neurological form, neuroborreliosis. It moves through the three stages of infection, then the clinical features and CSF findings, diagnosis, differential diagnosis including Bell's palsy and Guillain-Barré syndrome, and treatment with doxycycline or ceftriaxone. A summary of the classic European triad, Bannwarth syndrome, is included.

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Topic 51 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 300 words (2 min of reading), with 16 flashcards.

In this note

  1. Lympe disease

Lympe disease

Definition: Lyme disease is a multisystem infectious disease caused by the spirochete Lyme Disease due to Borrelia burgdorferi, transmitted by Ixodes ticks. Neurological involvement is called neuroborreliosis.

Etiology

  • Causative agent: Borrelia burgdorferi
  • Transmission: Tick bite (Ixodes tick)
  • Endemic in Europe and North America

Stages of Lyme Disease

Stage I – Early Localized Infection. Occurs days to weeks after tick bite.

  • Characteristic sign: Erythema migrans. Expanding annular ("bull's-eye") rash. Present in most patients
  • Other symptoms: Fever. Fatigue. Headache. Myalgia. Arthralgia

Stage II – Early Disseminated Disease: Weeks to months later.

  • Neurological manifestations (most important)
  1. 1. Lymphocytic meningitis: Headache. Neck stiffness. Mild meningeal syndrome
  2. 2. Cranial neuropathies: Facial nerve palsy (CN VII) most common. Often bilateral
  3. 3. Radiculoneuritis (Bannwarth syndrome): Severe radicular pain. Sensory symptoms. Motor weakness

Stage III – Late Lyme Disease: Months to years later.

  • Neurological features: Chronic encephalopathy. Cognitive impairment. Polyneuropathy. Myelopathy (rare)
  • Other manifestations: Chronic arthritis (especially knee). Acrodermatitis chronica atrophicans

Clinical Features of Neuroborreliosis

Triad (European form)

  • Bannwarth Syndrome: Painful radiculopathy. Cranial neuropathy (usually CN VII). Lymphocytic meningitis

Additional findings: Paresthesias. Weakness. Cognitive disturbances. Fatigue

Examination

  • Neurological Examination: Facial weakness (Bell's palsy-like). Sensory deficits. Radicular pain. Meningeal signs (sometimes)
  • General Examination: Erythema migrans. History of tick exposure

CSF Findings

Typical neuroborreliosis: Clear CSF. Lymphocytic pleocytosis. Mild ↑ protein. Normal glucose. Intrathecal Borrelia antibodies

Diagnosis

  • Serology: ELISA screening. Western blot confirmation
  • CSF studies: Borrelia-specific antibodies in CSF
  • Clinical clues: Tick exposure. Erythema migrans. Facial palsy

Differential Diagnosis

  1. 1. Viral meningitis: Similar CSF findings. No tick exposure
  2. 2. Bell's palsy: Isolated CN VII palsy. No meningitis/radiculopathy
  3. 3. Multiple sclerosis: Demyelinating lesions. Different CSF profile
  4. 4. Guillain-Barré syndrome: Symmetrical weakness. Areflexia

Treatment

  • Early disease: Doxycycline.
  • Neuroborreliosis: Ceftriaxone IV (commonly used). Alternatives according to severity and guidelines

Prognosis: Generally good with early treatment. Delayed treatment may lead to persistent neurological symptoms

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