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Cranial nerve palsies, SIADH and atrial fibrillation: a diagnostic challenge
  1. Rahul Karna,
  2. Bandhul Hans,
  3. Julie Murone and
  4. John Black
  1. Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Rahul Karna; rahulkarnagovind{at}


We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease—cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.

  • infection (neurology)
  • cranial nerves

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  • Twitter @RahulKarnaMD, @BandhulH

  • Contributors RK took care of the patient, took lead in conceptualising, design, data points collection, interpretation, writing the manuscript, reviewing the literature and revising it with support from BH, JM and JB. JB was the consultant taking care of the patient who supervised the manuscript preparation and revised the final version. RK, BH, JM and JB have approved the final version of the manuscript submitted for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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