title: Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization.
abstract: Neuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital.
  
  
  
  We retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study.
  
  
  
  Sixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood.
  
  
  
  In conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schwenkenbecher
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Refik
authors.initials: R
authors.lastname: Pul
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wurster
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Conzen
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Kaweh
authors.initials: K
authors.lastname: Pars
authors.affiliation: Department of Paediatrics, Hannover Medical School, Hannover, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Hartmann
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Kurt-Wolfram
authors.initials: KW
authors.lastname: Sühs
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Sedlacek
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stangel
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Trebst
authors.affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Skripuletz.Thomas@MH-Hannover.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Skripuletz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000134:cerebrospinal fluid; D000917:Antibody Formation; D001812:Blood-Brain Barrier; D025065:Borrelia burgdorferi / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003389:Cranial Nerve Diseases / Q000209:etiology*; D057210:Delayed Diagnosis; D004660:Encephalitis / Q000209:etiology*; D005260:Female; D006261:Headache / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007070:Immunoglobulin A / Q000134:cerebrospinal fluid; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008581:Meningitis / Q000209:etiology*; D008875:Middle Aged; D009187:Myelitis / Q000209:etiology*; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D011843:Radiculopathy / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D043025:Oligoclonal Bands