approximately 15% get neurological manifestations (neuroborreliosis), which usually occur within four weeks of the initial illness and resolve over 3 months. It is the most common complication of lyme disease in UK and may include (1,2):
meningoradiculoneuritis (Bannwarth's syndrome)
meningitis
cranial neuritis - usually VII, with palsy - very hard to distinguish from Bell's palsy
may be bilateral in up to 25% of individuals (3)
neuroborreliosis in children commonly manifests as facial nerve palsy, in contrast to adults who typically present with radiculoneuritis and lymphocytic CSF leocytosis (3)
Lyme radiculitis may present with signs resembling disc herniation
radicular neuritis (radiculoneuritis)
Lyme radiculitis may present with signs resembling disc herniation
pain is neuropathic, and dermatomal in distribution, while sensory defects and paresis may occur
parenchymal brain involvement is extremely rare
sporadic cases of chronic encephalitis or encephalomyelitis owing to Lyme borreliosis have been reported
cerebrovascular events resulting from CNS vasculitis have been associated with Lyme borreliosis, based on brain biopsy or intrathecal synthesis of anti-Borrelia antibodies, responding to antibiotic therapy
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