Lyme Neuroborreliosis Presenting as Bilateral Facial Nerve Palsy
TL;DR Summary: A diagnostic challenge involving bilateral cranial nerve VII paralysis as the sole clinical manifestation of Lyme neuroborreliosis.
Bilateral facial nerve palsy is a clinical rarity, occurring in less than 2% of facial palsy cases. It requires urgent diagnostic workup as it is often linked to systemic conditions.
Case Description
A 29-year-old female presented with progressive weakness in both sides of her face, resulting in difficulty closing her eyes and an inability to smile. She recalled a camping trip in New England 4 weeks prior but did not note any erythema migrans rash.
Evaluation and Findings
- Physical Examination: Bilateral weakness in all facial muscle groups (House-Brackmann grade IV).
- Lumbar Puncture: CSF analysis showed lymphocytic pleocytosis and elevated protein.
- Serology: CSF and serum ELISA/Western Blot confirmed positive antibodies for Borrelia burgdorferi.
Treatment and Resolution
The patient was prescribed a 21-day course of intravenous ceftriaxone, resulting in a full recovery of facial symmetry over the next three months.
Discussion & Comments