Bannwarth Syndrome Lyme Disease: Symptoms, Diagnosis, and Case Example
Can Lyme disease cause severe nerve pain, weakness, and even urinary problems? Bannwarth syndrome is a neurologic form of Lyme disease that can present with intense radicular pain and unusual neurologic symptoms.
This case highlights how early Lyme neuroborreliosis can be missed—and why recognizing neurologic patterns matters.
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses a 66-year-old man diagnosed with Bannwarth syndrome and urinary retention in early Lyme disease. :contentReference[oaicite:0]{index=0}
Omotosho and colleagues described this case in “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”
Case: Severe Pain, Weakness, and Urinary Retention
The patient presented to the emergency department with generalized muscle pain, fatigue, and severe neck pain beginning two weeks after tick exposure.
His symptoms progressed despite initial treatment for pneumonia.
“His pain then radiated down his entire spine into his upper and lower extremities, leading to right arm weakness and new urine retention onset,” the authors reported.
Additional findings included:
- Severe radicular pain (8/10)
- Diminished reflexes
- Elevated inflammatory markers (ESR 100 mm/h, CRP 8.8 mg/L)
This pattern is consistent with neurologic Lyme disease, where infection affects the nerves and spinal roots.
Diagnosis: Bannwarth Syndrome
Lyme disease was confirmed with positive ELISA and Western blot testing.
A spinal tap revealed lymphocytic pleocytosis and a positive Lyme titer.
The diagnosis of Bannwarth syndrome (BWS) was based on:
- Severe radicular pain
- Upper extremity weakness
- Urinary dysfunction
These findings reflect nerve root inflammation (radiculitis), a hallmark of Bannwarth syndrome.
This condition is often missed early and contributes to Lyme disease misdiagnosis, especially when symptoms do not match classic presentations.
Treatment and Outcome
The patient was treated with a 21-day course of intravenous ceftriaxone.
His symptoms improved significantly, with complete resolution of urinary retention.
This case demonstrates that even severe neurologic Lyme disease can improve with appropriate treatment.
What Is Bannwarth Syndrome?
Bannwarth syndrome is a neurologic manifestation of Lyme disease, most commonly reported in Europe but also present in the United States.
It is characterized by:
- Radicular pain (100%)
- Sleep disturbance (75%)
- Headache (46%)
- Fatigue and malaise
- Paresthesia
- Peripheral nerve palsy
- Meningeal signs
- Weakness (paresis)
The pain is often severe, burning, or stabbing—and frequently worse at night.
It may respond poorly to standard pain medications, making diagnosis more challenging.
Why Bannwarth Syndrome Is Often Missed
Bannwarth syndrome is underrecognized in the United States.
Several factors contribute:
- Symptoms mimic other neurologic or musculoskeletal conditions
- Pain may be mistaken for spine or disc disease
- Urinary symptoms may be attributed to unrelated causes
- Lack of awareness of this presentation
Failure to recognize this pattern can delay diagnosis and treatment.
Clinical Perspective
This case highlights the importance of recognizing neurologic Lyme disease beyond classic symptoms.
Severe radicular pain, weakness, and autonomic symptoms—such as urinary retention—should prompt consideration of Bannwarth syndrome.
When these symptoms occur after possible tick exposure, Lyme neuroborreliosis should be included in the differential diagnosis.
Early recognition and treatment can prevent progression and long-term neurologic complications.
Clinical Takeaway
Bannwarth syndrome is a neurologic form of Lyme disease characterized by severe nerve pain and radiculopathy.
Symptoms may include weakness and urinary dysfunction—features that can be misdiagnosed.
Prompt diagnosis and antibiotic treatment can lead to significant recovery.
Frequently Asked Questions
What is Bannwarth syndrome?
A neurologic manifestation of Lyme disease involving nerve root inflammation, severe pain, and neurologic symptoms.
Can Lyme disease cause urinary retention?
Yes. In this case, nerve involvement affected bladder function.
Is Bannwarth syndrome common in the U.S.?
It is less commonly recognized but does occur and may be underdiagnosed.
Can Bannwarth syndrome be treated?
Yes. Antibiotic treatment can lead to significant improvement and recovery.
Related Reading
References
- Omotosho YB, et al. Cureus. 2021.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I have came across an article which mentioned that Borrelia weakens immune system. It aparently blocks D receptors on the cells…
There are quite a number of suggested mechanisms for why tick borne illnesses can be difficult to treat. I follow these mechanisms closely. I do not know enough to be sure what mechanism will emerge for each tick borne infection.
There are quite a number of suggested mechanisms for why tick borne illnesses can be difficult to treat. I follow these mechanisms closely. I do not know enough to be sure what mechanism will emerge for each tick borne infection.
I have came across an article which mentioned that Borrelia weakens immune system. It aparently blocks D receptors on the cells…
Been diagnosed with Babesia, whenever I go off Mepron for more than 3-4 days, I get very clear urine retention.
This is my story about Lyme, Baanwarth Syndrome and receiving a Tetanus Booster Shot two years after contracting Lyme Disease
I came down with BAANWARTH SYNDROME in March of 2001 almost two years after I unknowingly was infected with Lyme & Babesia in 1999.
On February 15th, 2001 I was given a Tetanus Booster Shot and came down with chronic pain nearly three day later. Lyme and Babesia had turned off my immune system in June of 1999. I had two False Negative ELISA tests because I had a raging case of re-activated EBV.
Doctors denied I had Lyme even though I had every symptom for Lyme. In 2005 I had neck surgery for the chronic pain that I was in. At New England Baptist I had a Cervical Disectomy with fusion and a titanium cage after they removed C3-C5.
Of course it made my pain much, much worse and I was put on heavy drug medication fort which I needed.
Nobody figured out that I had Lyme or Babesia. I would later learn in 2001 that I was vaccinated with a Tetanus Booster almost two years after I contracted Lyme and Babesia. No Doctor would ever give a patient with Lyme Disease a Tetanus Vaccination, if they knew they had it.
I was fired by my local Doctor for not being able to manage my pain, after all my pain was caused by an ADVERSE EVENT to a Vaccine that should never have been given to me. I was on gabapentin for nerve pain and ritalin for focus.
I didn’t need a booster shot for two more years but they recommended the shot and I got it at a routine appointment. The real awful part of this story is that I went a full 15 years before I was able to get a positive Western Blot test and a positive Babesia Test and begin to receive medication for my infections..
I had been tested for Lyme and Babesia twice and they were both false negative because I had Mono as a kid that turned into a raging Epstein Barr Virus after contracting Lyme in June of 1999..
From 2014-2016 I took two years of antibiotics and other treatments for Lyme & Babesia.
I was reinfected 3 months later from a tic bite on my front porch which gave me Powassan Virus in less than 15 minutes, plus Erhlichia-Anaplasmosis, Lyme & Babesia Duncani (2nd time) and Powassan virus which no one would tests me for even today!
I was treated again from 2018-2021 and I finally recovered from the Lyme and Babesia. I live in chronic pain and will be on PAIN MEDS FOR THE REST OF MY LIFE.
I HOPE THIS STORY HELPS SOMEONE WHO LIVES in chronic Pain that might have been from a routine tetanus booster that was given after they had contracted Lyme. I believe the tetanus shot plus Lyme gave me Transverse Myelitis and Baanwarth’s Syndome.
I was not able to find peace in my life until I discovered “WHAT REAALY HAPPENED TO ME” some two years after I was infected with Lyme. If you are a Lyme survivor who is still in chronic pain, please check your medical records for vaccinations.
Of course, no one in the medical community will help you after your discovery of a being given a Tetanus vaccine. My experience anyway.
Vaccine Adverse Event Reporting System is only good for three years.
We pay .50 cents every time we get a vaccine and it goes into a slush fund to pay the medical bills of people who were injured by a vaccine. Of course after three years you can not make a claim. Crappy system.
I get all of my pain medication from a clinic and not a medical Doctor because the medical system is horribly broken, especially for people trying to get well after years of chronic Lyme Disease. Knowing what caused all of my pain has helped me tremendously! I never thought it would have been a routine vaccine.
Please check your Vaccination Records if you have Lyme and live in pain and don’t know why.
Sincerely,
Michael A Murphy