Six cases of neurological Lyme disease

older man in hospital bed with neurological lyme disease

Clinicians from Mayo Clinic describe 6 cases of neurological Lyme disease in the journal Open Forum Infectious Diseases. [1] Five of the cases presented with Bannwarth syndrome (BWS), an uncommon manifestation of neurologic Lyme disease.

Bannwarth syndrome is characterized by painful radiculopathy, neuropathy, varying degrees of motor weakness and facial nerve palsy, and cerebrospinal fluid (CSF) lymphocytic pleocytosis. Five patients presented with peripheral nervous system involvement (primarily axonal in nature), which is consistent with BWS, writes Shah and colleagues.  Three of the cases of neurological lyme disease are discussed below.

61-year-old male

A 61-year-old male, who had a history of daily exposure to ticks, presented with “progressive back pain, upper torso and extremity paresthesias, right-sided facial droop, and blurry vision in the right eye,” writes Shah. Four weeks prior, he was treated for an EM rash with 5 days of doxycycline, given twice daily.

Test results indicated positive IgM and IgG antibodies to B. burgdorferi and he was diagnosed with neurologic Lyme disease (also known as Lyme neuroborreliosis) and BWS. According to Shah, “the patient demonstrated significant neurologic improvement following 4 weeks of intravenous (IV) ceftriaxone.”

62-year-old female

A 62-year-old female presented with subacute onset of lower extremity weakness. This progressed over a 3-week period to flaccid paralysis, writes Shah. The woman also complained of radiating low back and abdominal pain with associated numbness.

[bctt tweet=”Study describes patients with Lyme disease presenting as Bannwarth syndrome. ” username=”DrDanielCameron”]

Tests confirmed the diagnosis of Bannwarth syndrome and neurologic Lyme disease. “A magnetic resonance image (MRI) of her spine showed diffuse inflammation of the cauda equine,” writes Shah. A pleocytosis by spinal tap and a positive real-time polymerase chain reaction (RT-PCR) assay confirmed the diagnosis.

After receiving a 4-week course of IV ceftriaxone, the woman reported that her mobility had improved. Although she still required extensive assistance for 2 months post-treatment, the authors explain.

29-year-old male

In June 2017, a 29-year-old male developed fever, myalgias, chills, headache, and fatigue. He also reported a transient erythematous (or EM) rash on his trunk. Two weeks later, he developed “right foot drop, Trendeleberg gait, lower extremity radiculopathy, and painful L5-S1 paresthesias,” explains Shah. And over the next 10 weeks, the man lost 15 pounds.

After refusing a spinal tap, the man was diagnosed based on his clinical presentation and positive Lyme disease test results. After two weeks of treatment with IV ceftriaxone, he reported having no symptoms. (It is not clear how often Bannworth syndrome occurs in actual practice with or without a confirmatory spinal tap.)

All 5 patients presented with upper or lower extremity radiculopathy and/or paresthesias. There were, however, several other findings. “The more widespread peripheral neuropathy observed for the remaining 3 patients in this series is somewhat atypical,” writes Shah, as “2 patients developed visual disturbances and nerve root enhancement in the cauda equina or lumbar spine, and 1 presented with Lyme disease-associated facial nerve palsy.”

The authors recommend, “The constellation of neurological symptoms, particularly when associated with a recent or suspected tick bite in a [Lyme disease]-endemic region, should prompt clinical evaluation for LNB [neurologic Lyme disease] and assessment for BWS [Bannworth syndrome] as this syndrome may be more common than previously presumed in North America.”

  1. Shah A, O’Horo JC, Wilson JW, Granger D, Theel ES. An Unusual Cluster of Neuroinvasive Lyme Disease Cases Presenting With Bannwarth Syndrome in the Midwest United States. Open Forum Infect Dis. 2018;5(1):ofx276.

31 Replies to "Six cases of neurological Lyme disease"

  • Pam H
    08/06/2019 (6:49 pm)

    My symptoms began with strange double vision, and nerve pain in my hands feet, including a burning /stabbing feeling at the bottom of the soles of my feet, all this one time for approximately two weeks. Now I have short term memory loss, inability to concentrate, letter reversal when spelling, extreme anxiety oh, a 40 pound weight loss, a 40 pound weight gain.
    I am thinking about being seen by Mayo clinic however I’ve heard negative reviews about them when testing for Lyme disease.
    I don’t know what to do because where I live all the Doctors and Hospital Systems I have gone to has dismissed my symptoms for psychiatric. I’m at a loss and want my life back…

  • China
    04/04/2018 (6:07 am)

    Diagnoses around 1988 and treated with in three weeks of a tick bite. I thought I was cured after taking the RX. Forgot about it until two months ago while conversing with some they had told me they have Lyme Disease and I had mentioned that I “had” it. I was told to get a test from my PCP…tested positive 2018 and to Doxicycline for 30 days.

    Went for an eye exam and shared an temporary blindness in one eye for 2-3 mins. one summer day, passed out twice (hit my head on sink’s edge on my way down). Past vehicle accidents w/head injuries. Been experiencing migraine for five years straight which began after three car accidents (while sitting still). Past three months eye pain, headaches while asleep that awakes me.

    My eye doctor referred me to an opthamologist who then ref. me to a neurologist whom ref. me to a neuro-ophthalmology neuro-ophthalmologist for lumbar puncture to measure spinal fluids, conduct a brain scan for tumors, and to be treated for Psendopapilledema and papilledema to save me from blindness and brain damage.

    The right side of my right arm started swelling with pain daily for eight weeks and right hand swelling. Then my left leg began swelling.

    Do you think my issues favor Psendopapilledema or pappedilema symptoms? My neuro-ophthalmology appt. is four weeks away.

    • Dr. Daniel Cameron
      04/04/2018 (8:34 am)

      I have often seen patients with a series of finding where a tick borne illness is a consideration. Your vision is a top priority and is being carefully evaluated. Your migraines, right arm swelling, left leg swelling, head trauma are additional concerns. There may be other issues you have not included in your notes. It would be reasonable to include an evaluation by a doctor familiar with tick borne pathogens.

  • Colleen
    03/14/2018 (4:35 am)

    It bothers me they still.insist on spinal tap when the regular unintrusive blood smear does the same thing…

    • Ellen Boehmer
      10/04/2019 (1:03 pm)

      …but the blood tests are not always positive. Mine were negative but lumbar puncture revealed the antibodies.

  • Kelly-Anne Bryan
    03/13/2018 (9:59 pm)

    Yeah, I had same type symptoms, never recognized for what it was. It actually resolves and relapses. Pretty sure this is VERY common in Lyme.

  • TC
    03/13/2018 (12:34 am)

    Quote- “… this syndrome may be more common than previously presumed in North America.” YA THINK? That’s why we call it Hold The Mayo! And they are just now figuring this out (or admitting it)? UGH!

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