Bannwarth's syndrome – A rare but important manifestation of neuroborreliosis in childhood
Aims: Bannwarth's syndrome is the most frequent symptom of Lyme neuroborreliosis in adults, but occurs only in 3.6% of neuroborreliosis in childhood. Prognosis in neuroborreliosis related motor radiculopathy is excellent in the majority of cases, and antimicrobial treatment the only necessary therapy.
Methods: We present 2 children with Bannwarth's syndrome, their clinical symptoms, diagnostic work up and outcome.
Results: A 9-year-old, previous healthy girl presented with headache for 2 weeks and pain in the right shoulder. Clinical examination revealed motor radiculopathy with bilateral areflexia of biceps reflex and asymmetric muscle weakness of shoulder elevation and flexion of the forearms. A tick bite on the left shoulder was documented 4 months prior to the onset with a short period of pain but no erythema. A 6-year-old boy presented with asymmetric motor radiculopathy of the lower limbs with bilateral areflexia of patellar and achilles reflexes and muscle weakness with difficulty to walk. A few days after onset, areflexia and muscle weakness in the right arm was noted. There was no tick bite in the history. Work up revealed revealed pleocytosis in CSF of 184 (181 mononuclear) and 193 (190 mononuclear) cells/µl, respectively. Protein was elevated in both, and glucose slightly decreased in one. Intrathecal production of Borrelia-burgdorferi antibodies was proven in both cases. After i.v. therapy for 14 days with ceftriaxone and meropenem respectively (allergic reaction to ceftriaxone in one) full recovery of the clinical symptoms was observed within 4 weeks.
Conclusions: Bannwarth's syndrome is a rare but important manifestation of neuroborreliosis in childhood, appearing as motor radiculopathy in lower or upper limbs. Neuroborreliosis should be searched for by intrathecal production of Borrelia-burgdorferi antibodies. Prognosis is excellent and the time to recovery may be influenced when treated appropriately.