# The Hidden Face of Lyme Disease: Neuroinfection With Cranial Nerve Involvement

## TL;DR

A 54-year-old woman with a tick bite and neurological symptoms was diagnosed with Lyme disease affecting the nervous system, highlighting the importance of considering this condition in similar cases.

## Contribution

This case highlights neuroborreliosis with cranial nerve involvement as a rare but important manifestation of Lyme disease.

## Key findings

- The patient's symptoms and CSF analysis confirmed neuroborreliosis with intrathecal antibody synthesis to Borrelia.
- Antibiotic treatment with ceftriaxone led to rapid clinical improvement.
- Neurological complications of Lyme disease can present with unusual symptoms, making diagnosis challenging.

## Abstract

The article presents the case of a 54-year-old woman who presented to the hospital for a diagnosis of persistent headaches. The patient had been unsuccessfully treated for two months, developing further complications in the form of visual disturbances and abducens nerve palsy. The patient reported a recent tick bite. Imaging studies in the form of a magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA), and transcranial Doppler ultrasound showed no abnormalities. In the next step, a lumbar puncture was performed, which yielded clear cerebrospinal fluid (CSF) with marked lymphocytic pleocytosis (122 cells/μL). CSF analysis confirmed the intrathecal synthesis of antibodies to Borrelia. Based on the clinical picture including the complications the patient developed, along with a history of tick bites, a diagnosis of neuroborreliosis with cranial nerve involvement was made. After starting antibiotic therapy with ceftriaxone, the patient showed significant clinical improvement after a few days. It should be remembered that in the course of Lyme disease, the nervous system can often be involved, resulting in many bothersome and unusual symptoms, which often make it difficult to make a correct diagnosis.