Neuropediatrics 2012; 43 - PS17_04
DOI: 10.1055/s-0032-1307132

Central nervous system Lyme disease – Presentation of two cases

H Schober 1, B Simma 1, J Lütschg 1, A Blassnig-Ezeh 1
  • 1Abteilung Kinder-und Jugendheilkunde, Feldkirch, Austria

Aims: Lyme Disease is a tick-borne illness caused by a species of the spirochete Borrelia.

The most common manifestation of nervous system Lyme disease is a cranial (mostly facial) nerve palsy.

In this report we present two cases with an unusual Lyme infection associated with a central nervous system infection.

Methods: Case 1

A previously healthy 13 year old boy showed a generalised seizure. A complex partial seizure was supposed because of EEG abnormality over the right hemisphere. Cerebral MRI was normal and an antiepileptic therapy was started.

One month later the patient noticed a left sided weakness in the upper limb.

A second MRI showed a localised oedema of the right frontal lobe with a subcortical white matter lesion.

Cerebrospinal fluid (CSF) revealed 11 mononuclear cells/µl, glucose and protein levels were normal. Serologic testing showed evidence for intrathecal antibody production against neuroborreliosis. After treatment with ceftriaxone for 3 weeks the neurological signs disappeared and follow-up EEG's and MRI were normal. No seizures or other neurological signs have occurred since then.

Case 2

A 12 year old boy suffered from neck pain for 2 weeks. He also noticed a loss of strength in both arms. The neurological examination was normal. MRI of the cervical spine showed a T2 and STIR hyperintense signal alteration from C1 to C3/4, suspicious for transverse myelitis.

In the CSF 294 mononuclear cells/µl and an elevated protein level of 121mg/dl were detected. Serologic testing was indicative for intrathecal antibody production against neuroborreliosis. A few days after starting antibiotic therapy the patient was free of symptoms. The follow-up MRI of the cervical spine one month later was normal.

Results: In this case report we present two patients with transitory inflammatory central nervous lesions due to Lyme disease.

Conclusion: Formerly healthy patients with acute and focal neurological symptoms who show brain or spinal cord lesions in the MRI have to be investigated for neuroborreliosis. Therapy with ceftriaxone is effective and the outcome of the neurological manifestation is good.

Lyme disease