ABSTRACT
There are acute and chronic Lyme neuropathies. The seasonal acute syndromes of cranial
neuritis or radiculoneuritis are generally quite distinctive, but may cause diagnostic
difficulty when one syndrome occurs without the other, when erythema migrans is absent
or missed, and when meningeal signs are minimal or absent. The chronic Lyme radiculoneuropathies
are less severe, and less distinctive. Their recognition depends on eliciting a history
of earlier classical manifestations of Lyme disease and by laboratory testing. In
both acute and chronic Lyme radiculoneuropathy, electrophysiologic testing often proves
the presence of a sensorimotor, axon loss polyradiculoneuropathy. Both acute and chronic
Lyme radiculoneuropathy have similar pathologic features and can be classified as
a nonvasculitic mononeuritis multiplex. The pathogenesis is uncertain; both direct
infection as well as parainfectious mechanisms may play a role. The treatment with
which we have the most experience is intravenous ceftriaxone 2 g/day for 2 to 4 weeks.
Improvement occurs rapidly over days to weeks in early Lyme neuroborreliosis, but
slowly over many months in chronic neuroborreliosis.
Keywords
Lyme disease - neuropathy - radiculopathy - cranial neuropathy - meningitis
