Lyme disease presenting with multiple cranial neuropathies on MRI

Piché-Renaud PP, Branson H, Yeh EA, Morris SK.
IDCases. 2018 Apr 11;12:117-118. eCollection 2018.


We present the case of a 10-year old patient from southeastern Ontario with severe bilateral facial palsy. MRI was performed that showed extensive symmetric enhancement of cervical cranial nerve roots and multiple cranial nerves (III, V, VI, VII, VIII, X and XII).

Lumbar puncture was performed that revealed pleocytosis and elevated proteins in the cerebrospinal fluid. Serology confirmed the diagnosis of neuroborreliosis. The patient was treated with a 4-week course of IV ceftriaxone, following which he returned to baseline.



This case is a perfect example of the importance understanding the organism and of the need for follow up.  The case study follows the idea that borrelia can be eradicated quickly and easily which is just not to case for many patients.

It is my strong opinion that people once infected with Lyme/MSIDS should be checked yearly if not more frequently for symptoms.  Once Bb is in the central nervous system, it can proliferate anywhere.  Follow up would show most probably show symptoms that come and go that are directly related to infection.  People treated like this often fall through the cracks and physicians do not connect later symptoms with previous infection.

For an example of how a successful doctor, also a founding member of the IDSA,  treated Lyme/MSIDS cases right here in Wisconsin:

“….two protocols to be considered for the treatment of chronic LD that includes 6-8 grams of IV ceftriazone for at least 6 weeks and longer if the syndrome has entrenched itself for over a year or if the response is coming along slowly. In tandem with the IV antibiotics he typically also used doxycycline, an erythromycin, Diflucan, Flagyl, Valtrex, and gamma globulin. When there was not a satisfactory clinical response he would treat Babesia with Mepron and/or other antimalarials. For evidence of intransigent bartonellosis (Bell’s palsy of the face and gut, and chronic dermatitis) he would add rifampin and sometimes intravenous genamicin.  That’s a far cry more than the CDC/IDSA mono treatment mandate of doxycycline.

Notice the overlapping treatment?  This is how most knowledgable practitioners treat this complex illness which automatically takes into account the probably of other pathogens besides Bb.

For more treatment options:

More cases of cranial neuropathy: