Abstract Details

Title Multiple Cranial Neuropathies: Unusual Presentation of Lyme Disease

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 208

Objective

Background BACKGROUND: Lyme disease is a bacterial infection caused by the Borrelia burgdorferi, transmitted by tick bite. It can cause multi-system involvement; the typical neurological manifestations being facial palsy, painful radiculopathy, and meningitis. Multiple cranial neuropathy as initial presentation of Lyme disease is rarely seen.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 35 year old woman, veterinary technician working with primates, with no significant past medical history presented with a two day history of right facial droop, right facial numbness, and altered taste sensation. This was preceded by intermittent headache and migratory arthralgia for three weeks. The neurological examination showed signs consistent with right lower motor neuron facial nerve palsy, involvement of right trigeminal nerve, and left abducens nerve paresis. Laboratory tests revealed Borrelia burgdorferi IgM antibodies in high titers (8.9 index value, reference range <0.9); IgG antibodies were negative indicating acute infection. Cerebrospinal fluid analysis showed elevated protein levels (87 mg/dl), leukocytosis (416 cell/mm3), positive Lyme antibodies, elevated total IgG levels and high IgG synthesis rate. Brain MRI demonstrated contrast enhancement of the bilateral trigeminal and facial nerves. The patient was treated with a four week course of intravenous ceftriaxone. On the tenth day, her clinical symptoms had completely resolved and brain MRI obtained at that time showed attenuation of cranial nerve enhancement.

Conclusions CONCLUSIONS: Multiple cranial neuropathies can be a rare presentation of acute Lyme disease and physicians should be aware of this possibility. Early diagnosis and treatment can lead to good clinical outcome.

Authors/Disclosures
Ajay M. Tunguturi, MD (Hartford HealthCare) PRESENTER	Dr. Tunguturi has nothing to disclose.
Saef Izzy, MD, FAAN (Brigham and Women'S Hospital, Harvard Medical School)	The institution of Dr. Izzy has received research support from NINDS. The institution of Dr. Izzy has received research support from The Gillian Reny Stepping Strong Center for Trauma Innovation. Dr. Izzy has received publishing royalties from a publication relating to health care.
Federica Agosta (San Raffaele Scientific Institute)	Federica Agosta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philips. Federica Agosta has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier INC.
	No disclosure on file
Neeta Garg, MD (Harbor UCLA Medical Center)	Dr. Garg has nothing to disclose.

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