The triad of neurologic manifestations of Lyme disease

TLDR

Lyme disease can present with a triad of neurologic manifestations—meningitis, cranial neuritis, and radiculoneuritis—forming a distinctive clinical picture. The study examined 38 patients diagnosed with Lyme meningitis, a newly recognized spirochetal infection. Patients exhibited intermittent severe headache, mild meningismus, lymphocytic pleocytosis, and, in addition, subtle encephalitic signs, cranial neuritis (often facial palsy), and radiculoneuritis or plexitis, with neurologic symptoms lasting 3–18 months without antibiotic treatment.

Abstract

We studied 38 patients with Lyme meningitis, a newly recognized spirochetal infection. The patients characteristically had intermittent attacks of severe headache, mild meningismus, and a predominantly lymphocytic pleocytosis. In addition to meningitis, 11 patients experienced subtle encephalitic signs, 19 had cranial neuritis, most commonly unilateral or bilateral facial palsy, and 12 developed peripheral radiculoneuritis, plexitis, or mononeuritis multiplex. Without antibiotic therapy, the duration of neurologic involvement was 3 to 18 months. Although sometimes incomplete, the triad of neurologic manifestations of Lyme disease— meningitis, cranial neuritis, and radiculoneuritis—presents a unique clinical picture.