Characteristics of Lyme optic neuritis: a case report of Lyme associated bilateral optic neuritis and systematic review of the literature

Lu, Yezhong; Zand, Ramin

doi:10.1186/s12883-022-02627-z

Cited by 4 publications

(8 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lyme disease is one of the most prevalent arthropod-borne illnesses in the Northern Hemisphere, and the number of reported cases in the United States has increased from 7,943 in 1990 to 18,000 in 2020 [ 6 - 7 ]. It has many clinical manifestations and affects the body's multisystem.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, optic neuritis is infrequent in Lyme borreliosis, often leading to its omission from consideration in the initial differential diagnosis for patients with acute vision loss [ 8 ]. Untreated Lyme neuroborreliosis may lead to delayed neurological manifestations, such as encephalomyelitis, chronic meningitis, and cerebral vasculitis, manifesting months or even years post-infection [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…As such, it is imperative for patients exhibiting symptoms indicative of Lyme neuroborreliosis to undergo thorough CSF and serum antibody testing for Borrelia burgdorferi. In addition, physicians should exercise caution in interpreting results, acknowledging that numerous cases of Lyme neuroborreliosis may go undiagnosed [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss

Wan,

Yan,

Reese

et al. 2024

Cureus

View full text Add to dashboard Cite

Acute vision loss is a prevalent clinical manifestation associated with a broad spectrum of differential diagnoses, encompassing demyelinating diseases, neoplastic processes, autoimmune disorders, and infectious conditions. A rare but noteworthy infectious etiology contributing to acute vision loss is neurological Lyme disease (Lyme neuroborreliosis)-induced optic neuritis. Lyme disease, a vector-borne illness caused by the spirochete Borrelia burgdorferi , has the potential to affect multiple physiological systems and unfolds in three distinct stages. Another significant contributor to acute vision loss is giant cell arteritis, an autoimmune vasculitis that commonly affects large- and medium-sized vessels, including the temporal and ophthalmic arteries. This relatively common condition may manifest with symptoms, such as jaw claudication, headaches, and visual disturbances. The precise identification of the underlying cause of acute visual loss is of utmost importance for physicians, as it is instrumental in averting undesirable complications. An 80-year-old female presents to the emergency room with a sudden onset of blurry vision of the left eye, right-sided weakness, dysarthria, jaw pain, headache, and left facial droop. Following consultations with rheumatology and ophthalmology specialists, giant cell arteritis emerged as a primary consideration in the differential diagnosis for the observed vision loss. Subsequently, a temporal artery biopsy was conducted, definitively confirming the diagnosis of giant cell arteritis. Considering the patient's residence in an area endemic to Lyme disease, a Lyme immunoglobulin G (IgG) titer was ordered. The results returned positive, suggesting the presence of Lyme neuroborreliosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss

Wan,

Yan,

Reese

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…A number of ophthalmologic conditions have been associated with Lyme disease, including uveitis, conjunctivitis, keratitis, periorbital edema, cotton wool spots, and papilledema [37 ▪ ].…”

Section: Optic Neuritis and Other Optic Nerve Involvementmentioning

confidence: 99%

“…The patients came from both Europe and North America, so distinct Borrelia species may have been involved. The most common symptoms reported in these patients were blurry vision and headache [37 ▪ ]. It is important to note that afferent pupillary defect was reported in only two patients and painful eye movements were reported in only three of these patients, whereas over 90% of patients with typical optic neuritis report eye pain [39].…”

Section: Optic Neuritis and Other Optic Nerve Involvementmentioning

confidence: 99%

Cranial nerve involvement, visual complications and headache syndromes in Lyme disease

McEntire,

Chwalisz

2024

Current Opinion in Ophthalmology

View full text Add to dashboard Cite

Purpose of review To provide a summary of the visual manifestations and cranial neuropathies seen in Lyme disease. Recent findings Lyme facial palsy remains the most common manifestation of Lyme neuroborreliosis. Recent investigations show likely evidence of vagal involvement in Lyme disease. Summary The literature on Lyme neuroborreliosis continues to evolve. Lyme disease can affect nearly any cranial nerve in addition to causing various headache syndromes. The most common manifestation is Lyme disease facial palsy, occurring in up to 5–10% of patients with documented Lyme disease. Headache syndromes are common in the context of facial palsy but can occur in isolation, and more specific headache syndromes including trigeminal and geniculate neuralgias can occur rarely. Signs and symptoms indicative of vestibulocochlear nerve involvement are relatively common, although it could be that these represent other vestibular involvement rather than a specific cranial neuropathy. Optic neuritis is a controversial entity within Lyme disease and is likely overdiagnosed, but convincing cases do exist. Physicians who see any cranial neuropathy, including optic neuritis, in an endemic area can consider Lyme disease as a possible cause.

show abstract

Neuroborreliosis

He,

Al Lawati,

Torun

et al. 2024

Infect Dis Clin Pract

View full text Add to dashboard Cite

Background Neuroborreliosis is involvement of the nervous system in Lyme disease and can often be overlooked as a diagnosis in patients presenting with cranial neuropathies and meningitis in an endemic area. There can be variability in presentation with respect to the involved cranial nerves, making the diagnosis challenging. To the best of our knowledge, there have been no reported cases of Lyme disease cranial neuropathy occurring with simultaneous periorbital skin and soft tissue inflammation in the literature. Case We present the case of a healthy 25-year-old man who presented to the emergency department with headache, diplopia, and left eye pain after experiencing fever, malaise, and a recent history of unilateral facial palsy that improved a few weeks prior. He lived in a Lyme disease endemic area and often encountered ticks. He was found to have an abduction deficit in his left eye, preseptal and postseptal orbital inflammation with bilateral optic perineuritis, and a lymphocytic pleocytosis in the cerebrospinal fluid accompanied by an elevated antibody index, consistent with a diagnosis of Lyme neuroborreliosis. He was treated with doxycycline and empiric bacterial coverage, with symptom resolution at follow-up. Conclusion This case represents an unusual combination of cranial neuropathies and is the first report of orbital inflammation driven by Lyme neuroborreliosis, thought to be caused by contiguous spread of inflammation from affected portions of the nervous system. Although neuroborreliosis is less commonly encountered in the United States than in Europe, providers should maintain a high index of suspicion for this entity when patients present with multiple cranial neuropathies in an endemic area and not exclude Lyme disease on the basis of skin and soft tissue inflammation.

show abstract

Characteristics of Lyme optic neuritis: a case report of Lyme associated bilateral optic neuritis and systematic review of the literature

Cited by 4 publications

References 61 publications

Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss

Through the Eyes of Uncertainty: Giant Cell Arteritis and Lyme Neuroborreliosis in a Story of Vision Loss

Cranial nerve involvement, visual complications and headache syndromes in Lyme disease

Neuroborreliosis

Contact Info

Product

Resources

About