BMJ Case Reports 2018; doi:10.1136/bcr-2017-223307
  • Unusual presentation of more common disease/injury

Cranial neuropathy and severe pain due to early disseminated Borrelia burgdorferi infection

  1. Muhammad Rizwan Sohail3
  1. 1 Division of General Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  2. 2 Division of Neurology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3 Division of Infectious Disease, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  1. Correspondence to Dr Muhammad Rizwan Sohail, sohail.muhammad{at}
  • Accepted 3 January 2018
  • Published 23 January 2018


A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at the scalp and spine. Prior work up was unrevealing. The patient resided in the upper Midwest region of the USA and worked outdoors, optimising the landscape for white tailed deer. Repeat cerebrospinal fluid testing revealed a lymphocytic pleocytosis and positive IgM Lyme serology. Brain MRI demonstrated enhancement of multiple cranial nerves bilaterally. He was diagnosed with early Lyme neuroborreliosis and treated with 28 days of intravenous ceftriaxone. While the painful meningoradiculitis, also known as Bannwarth syndrome, is more commonly seen in Europe, facial palsy is more frequently encountered in the USA. Clinical manifestations of neuroborreliosis are important to recognise as the classic presentation varies by geography and on occasion repeat serological testing may be necessary.


  • Contributors DE: Drafting of manuscript and literature review. KS: Drafting of manuscript and planning. DD: Concept and critical review of manuscript. RS: Critical review of manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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