TY - JOUR T1 - Lyme neuroborreliosis presenting as spinal myoclonus JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-233162 VL - 12 IS - 12 SP - e233162 AU - Xena Li AU - Aaron Kirschner AU - Mary Metrie AU - Mark Loeb Y1 - 2019/12/01 UR - http://casereports.bmj.com/content/12/12/e233162.abstract N2 - Early neurological Lyme disease (neuroborreliosis) typically presents with well-recognised neurological syndromes. Spinal myoclonus is however a rare manifestation of neuroborreliosis. We present the case of a man who developed spinal myoclonus 3 weeks after returning from the Czech Republic where he developed erythema migrans on his arm following multiple tick exposures. Spinal fluid analysis showed a pleocytosis and MRI showed enhancement at C5-C6. His serology was positive for IgM antibodies to Borrelia afzelli. He was successfully treated with ceftriaxone and doxycycline with improvement of his spinal myoclonus and radiculitis. We conclude that early Lyme neuroborreliosis may present with uncommon neurological manifestations and so a high degree of suspicion is needed. ER -