Abstract
Lyme disease is caused by a spirochete, Borrelia burgdorferi. The hallmark of acute localized Lyme disease is erythema migrans, which is a slowly expanding erythematous lesion that may have a partial central clearing. The most common form of neurological Lyme disease is headache with neck stiffness, low-grade fever, and a unilateral or bilateral (in 25% of cases) facial nerve palsy. The serodiagnosis of Lyme disease is a two-step process. The screening serological test for Lyme disease is an enzyme-linked immunosorbent assay (ELISA) or an indirect fluorescent antibody test. A positive ELISA is confirmed with a Western immunoblot. The classic cerebrospinal fluid abnormalities in nervous system Lyme disease are lymphocytic pleocytosis, increased protein concentration, normal glucose concentration, elevated immunoglobulin G (IgG) index, and oligoclonal bands. Definitive diagnosis requires demonstration of intrathecal anti-B. burgdorferi antibody production. The majority of patients with headache, low-grade fever, and facial nerve palsy can be treated with oral doxycycline.
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