The triad of neurologic manifestations of Lyme disease

Abstract

We studied 38 patients with Lyme meningitis, a newly recognized spirochetal infection. The patients characteristically had intermittent attacks of severe headache, mild meningismus, and a predominantly lymphocytic pleocytosis. In addition to meningitis, 11 patients experienced subtle encephalitic signs, 19 had cranial neuritis, most commonly unilateral or bilateral facial palsy, and 12 developed peripheral radiculoneuritis, plexitis, or mononeuritis multiplex. Without antibiotic therapy, the duration of neurologic involvement was 3 to 18 months. Although sometimes incomplete, the triad of neurologic manifestations of Lyme disease--meningitis, cranial neuritis, and radiculoneuritis--presents a unique clinical picture.

Chronic unremitting headache associated with Lyme disease-like illness

“…Several types of headaches have been reported to be associated with LD 4,12,13,[15][16][17][18] (Table 2). In a large sample of confirmed LD patients, headache, orofacial, and dental pains were reported to be common complaints 12 .…”

“…Migraine-like headaches 13 Tension-type headaches 17 Headaches associated with intracranial hypertension 4,17 Headaches associated with Lyme Disease meningitis 4,13,17 Headaches associated with cranial nerve involvement 13 Headaches associated with ocular disease 15 Headaches resembling temporal arteritis 16 Facial, dental, and/or orofacial pain 12 …”

“…Since this microorganism is difficult to culture, the disease is usually diagnosed by serological tests 3 . The most common neurological presentations of LD are meningitis, cranial neuritis, and radiculoneuritis 4 . Brazilian Lyme-disease-like illness (BLDLI) or BaggioYoshinari syndrome (BYS) is a unique zoonosis found in Brazil.…”

“…However, there are few reports of LD where chronic unremitting headache is the only primary symptom 4,[16][17][18] . Diagnosis of atypical headaches can pose a problem, especially in patients who previously presented with migraine headaches, since in these patients non-migrainous ones may be a part of the spectrum of migraine 19 .…”

Lyme borreliosis

“…As the erythema migrans resolves, spirochetes complete their migration through the skin and enter other organ systems, where they cause symptoms referable to the tissues invaded. Objective manifestations associated with early disseminated Lyme borreliosis include meningitis and cranial nerve deficits (most commonly a unilateral facial nerve palsy) 72 and atrioventricular conduction deficits. 73 If not treated, the disease will progress in some patients to late disseminated symptoms, characterized by large joint oligoarthritis 74 and central nervous dysfunction, commonly encephalopathy and radiculopathies.…”