Cranial neuropathy and severe pain due to early disseminated Borrelia burgdorferi infection
Published January 23rd, 2018 doi:10.1136/bcr-2017-223307
[CanLyme Note: What is sick about this case report is that this man’s health outcome, which should be an educational source for all is being sold for profit by the British Medical Journal – just as other alleged “esteemed’ medical journals do. We must stop this institutionalized rape of our personal information.]
A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at the scalp and spine. Prior work up was unrevealing. The patient resided in the upper Midwest region of the USA and worked outdoors, optimising the landscape for white tailed deer. Repeat cerebrospinal fluid testing revealed a lymphocytic pleocytosis and positive IgM Lyme serology. Brain MRI demonstrated enhancement of multiple cranial nerves bilaterally. He was diagnosed with early Lyme neuroborreliosis and treated with 28 days of intravenous ceftriaxone. While the painful meningoradiculitis, also known as Bannwarth syndrome, is more commonly seen in Europe [but seen in North America but likely missed as this report suggests] , facial palsy is more frequently encountered in the USA. Clinical manifestations of neuroborreliosis are important to recognise as the classic presentation varies by geography and on occasion repeat serological testing may be necessary.