SHM Converge Scientific Abstract ePoster Gallery-Neuroborreliosis: An Unusual Presentation of This Tick Borne Disease

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This case report describes a 72-year-old man with hypertension and gout who presented with diplopia and muscle cramps. His initial workup, including MRI brain and MRA head/neck, was negative, and he was first treated as a possible posterior circulation TIA. Over the next few days, his symptoms evolved to include left eye visual changes and later right facial droop with perioral numbness. The differential diagnosis included microvascular cranial nerve palsy, myasthenia gravis, myositis, and Lyme disease.<br /><br />Lyme serology ultimately returned positive, including Lyme titer screen, IgG Western blot, and antibody screen, while other workup was negative. He was diagnosed with neuroborreliosis and treated with 4 weeks of IV ceftriaxone via PICC line. His neurological symptoms did not resolve immediately but improved significantly over the following weeks.<br /><br />The presentation highlights that early Lyme neuroborreliosis can occur within weeks of infection and may present with isolated or multiple cranial nerve palsies, most commonly facial nerve involvement, but also less commonly oculomotor palsy. Importantly, patients may not recall a tick bite and may lack classic meningeal symptoms, making diagnosis challenging. In endemic areas such as New England and the mid-Atlantic, clinicians should maintain a high suspicion for Lyme neuroborreliosis when unexplained cranial neuropathies occur, even if initial brain imaging is normal.<br /><br />The authors emphasize that timely recognition and antibiotic treatment are important to prevent persistent or permanent neurologic deficits.

Asset Subtitle

Salahuddin Nasir

Meta Tag

Author List Chris Musgrove, Janaki Makadia, Mohamed Yassin Yassin, Padma Sri Katikaneni, Salahuddin Nasir, Tanisha Kaur

Category Clinical Vignettes

Concept Lyme Neuroborreliosis

Concept Serology

Concept Cranial Nerve Palsy

Concept Peripheral Facial Nerve Palsy

Concept Ophthalmoplegia

Distinguished Non-Finalist

Presenter Organization University of Pittsburgh Medical Center

Presenting Author Salahuddin Nasir

Track Adult

Keywords

Lyme neuroborreliosis

cranial nerve palsy

diplopia

facial droop

ceftriaxone

IgG Western blot

posterior circulation TIA

neuroborreliosis diagnosis

tick-borne infection

New England endemic area

Lyme Neuroborreliosis

Serology

Cranial Nerve Palsy

Peripheral Facial Nerve Palsy

Ophthalmoplegia