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Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area
  1. Marta Ezequiel,
  2. Ana Teresa Teixeira,
  3. Maria João Brito,
  4. Catarina Luís
  1. Department of Pediatria, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
  1. Correspondence to Dr Marta Ezequiel, marta.ezequiel{at}


Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.

  • headache (including migraines)
  • neuro-ophthalmology
  • meningitis
  • tropical medicine (infectious disease)
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  • Contributors ME and ATT: conception, design, analysis and interpretation of lab results. ME: drafting the article. MJB and CL: revising it critically for important intellectual content. ATT, MJB and CL: final approval of the version to be published. All authors read and approved the final manuscript.

  • 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.

  • Patient consent Parental/guardian consent obtained.

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

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