2019 Dec 2;11(4):8318. doi: 10.4081/ni.2019.8318. eCollection 2019 Nov 29.

Atypical presentation of Lyme neuroborreliosis related meningitis and radiculitis.


Lyme disease related central and peripheral nervous system manifestations can occur in isolation or together. Radiculitis or inflammation of the nerve root can be seen 3-5% of the time in acute neuroborreliosis affecting the PNS with a typical presentation and meningitis affecting the CNS is usually seen 1% of the time. The appropriate diagnosis and management of neuroborelliosis can be challenging and require meticulous medical approaches. Herein we present a unique case of Lyme disease with neurologic manifestations including both radiculitis and meningitis due to its atypical and challenging clinical presentation and management with updated literature review.



I assure you, Meningitis and Radiculitis are NOT atypical with Lyme. The problem is many cases just do not get into the literature for a variety of reasons. Again, to get into research studies they often mandate an EM rash and a positive on testing, which is like winning the lottery.

Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial (such as Lyme) or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling. However, injuries, cancer, certain drugs, and other types of infections also can cause meningitis.  This link also states that parasites, fungus, and amoebas can cause it (all of which can play a part in tick-borne illness).

Radiculitis may occur with Lyme disease as infection causes a localized inflammatory reaction in the root of a nerve or somewhere along the nerve itself.

Ironically, this 2017 states both can be presentations of Lyme:

Excerpt:  Classic symptoms of Lyme neuroborreliosis include radiculoneuritis, cranial nerve abnormalities, and meningitis. Without a higher clinical suspicion for Lyme disease or other concomitant signs or symptoms, the diagnosis can be easily missed…..Lyme disease is well-known to have symptoms of radiculitis and should be considered in the assessment of cervical pain. A typical early syndrome due to neuroborreliosis has been characterized as a triad of the symptoms mentioned above including radicular pain, cranial or peripheral paresis, and lymphocytic meningitis and is called “Bannwarths syndrome” (Bannwarth, 1941).

And here we see a cluster of Bannwarth cases right here in Wisconsin and Minnesota:




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