title: Uncommon manifestations of neuroborreliosis in children.
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.
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology and Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. matthias.baumann@uki.at
authors.forename: Matthias
authors.initials: M
authors.lastname: Baumann
authors.forename: Robert
authors.initials: R
authors.lastname: Birnbacher
authors.forename: Johannes
authors.initials: J
authors.lastname: Koch
authors.forename: Robert
authors.initials: R
authors.lastname: Strobl
authors.forename: Kevin
authors.initials: K
authors.lastname: Rostásy
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000166:cytology; D002648:Child; D003389:Cranial Nerve Diseases / Q000382:microbiology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007964:Leukocytosis / Q000382:microbiology; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008581:Meningitis / Q000382:microbiology*; D009188:Myelitis, Transverse / Q000382:microbiology*; D011843:Radiculopathy / Q000382:microbiology; D012640:Seizures / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G