Transverse myelitis and sixth cranial nerve palsy – Two rare presentations of neuroborreliosis

Abstract

Introduction: Facial palsy and lymphocytic meningitis are the most common manifestations of neuroborreliosis in childhood. We would like to focus on two rare but important presentations of CNS borreliosis. Case 1: 13 year old boy with backache for 2 weeks and hyperesthesia in the 11th dermatom. On clinical examination there was localised pain over the fifth lumbar vertebra and reduced lumbar spine flexibility with neck stiffness. The spinal MRI showed central medullary edema from TH 7 to 11. In the CSF lymphocytic pleocytosis with intrathecal IgM-production was found. Transverse myelitis as a manifestation of CNS borreliosis was diagnosed, which was confirmed by microbiological testing. Case 2: 5 year old boy with esotropia of the left eye and double vision for 2 weeks. On neurological examination isolated palsy of the left sixth cranial nerve was found. CSF analysis showed typical finding for neuroborreliosis. Discussion: Both patients were treated with parenteral antibiotics. There was a complete and prompt resolution of the neurological symptoms. In both clinical manifestations the diagnosis of neuroborelliosis can be made by the typical laboratory results of lymphocytic pleocytosis and intrathecal IgM-production in the CSF. Early antibiotic treatment is curative with excellent prognosis for complete neurological recovery.