Is the presence of antibodies in CSF sufficient to make a definitive diagnosis of Lyme disease?

Abstract

In clinical practice, the possibility of neurologic Lyme disease is raised by physicians during tick season in endemic regions in patients with headache, meningismus, seventh cranial nerve palsies, radiculopathy, or mononeuritis multiplex and a CSF lymphocytic pleocytosis, and by patients in endemic and nonendemic regions throughout the year as an explanation for their fatigue and aches and pains. In the United States, the most common manifestation of neurologic Lyme disease is a seventh nerve palsy.1 Patients should be questioned about tick bites and rash and examined for an erythema migrans lesion, which should be at least 5 cm in largest diameter, as the majority of patients with Lyme disease have or have had an erythema migrans lesion.2 Serology is obtained for ELISA or immunofluorescence antibody, and when positive followed by a Western blot. In the United States, the demonstration of anti- Borrelia burgdorferi antibodies in CSF is regarded as definitive evidence of neurologic Lyme …