Case study
Uncommon manifestations of neuroborreliosis in children

https://doi.org/10.1016/j.ejpn.2009.08.003Get rights and content

Abstract

Lyme borreliosis is a tick-borne spirochetal infection which affects the skin, joints, heart and nervous system. Children with a neuroborreliosis usually present with a facial nerve palsy or aseptic meningitis, but the spectrum also includes other rare manifestations. We report four unusual cases of childhood neuroborreliosis and show that seizures with regional leptomeningeal enhancement, acute transverse myelitis, meningoradiculitis with pain and paraesthesia and cranial nerve palsies other than facial nerve palsy can be the leading symptoms of children with neuroborreliosis. All children had serological evidence of an acute infection with Borrelia burgdorferi, a pleocytosis in the cerebrospinal fluid and a complete response to antibiotic treatment. An intrathecal synthesis of IgG antibodies was detected in three children. Thus, diagnostic work up in children with unusual neurological symptoms should include cerebrospinal fluid studies with determination of the white blood cell count and calculation of the antibody index against B. burgdorferi.

Introduction

Lyme borreliosis is a tick-borne infection and in Europe caused by at least four species of the spirochete Borrelia burgdorferi sensu lato (B. burgdorferi sensu stricto, B. afzelii, B. garinii and B. spielmanii). It presents as a multisystem disease involving the skin, nervous system, joints and heart. Children with neuroborreliosis commonly have a peripheral facial nerve palsy or aseptic meningitis, but the spectrum includes other rare manifestations. Additionally the laboratory diagnosis of neuroborreliosis can be challenging. The diagnostic criteria of the German Neurological Society (DGN) for a secured neuroborreliosis include the typical clinical symptoms such as meningism or facial nerve palsy, CSF pleocytosis and an elevated specific B. burgdorferi CSF to serum antibody index (AI), or the detection of B. burgdorferi by culture or PCR.

To draw attention to the wide range of neurologic manifestations of infections with B. burgdorferi we present four unusual cases of neuroborreliosis in children.

Section snippets

Case 1

A 6 year old boy was admitted for further work up because of two epileptic seizures. The first episode occurred two days prior to admission when he suddenly fell to the ground while playing. He was unable to move his left arm and leg for several minutes, but was fully alert. On the day of admission he fell again and started twitching with all four extremities with the head turned to the right. This was followed by a postictal left sided hemiparesis lasting an hour.

Initial physical and

Discussion

Here we present four children with a neuroborreliosis, which were diagnostically challenging because of their unusual presentation.

The first child presented with focal and secondary generalised seizures and regional leptomeningeal enhancement over one hemisphere. Epileptic seizures in children in the course of neuroborreliosis have only been sporadically described, mostly in conjunction with parenchymatous lesions or a meningoencephalitis.1, 2, 3 A vasculitis is thought to be the primary

References (14)

  • J. Köchling et al.

    Lyme disease with lymphocytic meningitis, trigeminal palsy and silent thalamic lesion

    Europ J Paediatr Neurol

    (2008 Nov)
  • D. Vukelic et al.

    Opsoclonus-myoclonus syndrome in a child with neuroborreliosis

    J Infect

    (2000)
  • H.J. Christen et al.

    Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis

    Acta Paediatr Suppl

    (1993)
  • M. Wilke et al.

    Primarily chronic and cerebrovascular course of Lyme neuroborreliosis: case reports and literature review

    Arch Dis Child

    (2000)
  • H.M. Feder et al.

    Lyme disease: acute focal meningoencephalitis in a child

    Pediatrics

    (1988)
  • C. Mantienne et al.

    MRI in Lyme disease of the spinal cord

    Neuroradiology

    (2001)
  • P. Demaerel et al.

    Lyme disease in childhood presenting as primary leptomeningeal enhancement without parenchymal findings on MR

    AJNR Am J Neuroradiol

    (1994)
There are more references available in the full text version of this article.

Cited by (26)

  • Cerebrovascular events in lyme neuroborreliosis

    2015, Journal of Stroke and Cerebrovascular Diseases
  • Pathologic Approach to Spinal Cord Infections

    2015, Neuroimaging Clinics of North America
    Citation Excerpt :

    These organisms more commonly involve the cranial meninges. In addition, many other species can be isolated from spinal meninges.8–12 Common and uncommon pathogens are also reported as the cause of abscess and meningitis following surgery or trauma to the spinal cord.5,10,11

View all citing articles on Scopus
View full text