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067 Bannwarth syndrome presentation of neuroborreliosis, with radiological evidence of CNS demyelination
  1. Tim Soane1,
  2. Fahad Shaikh1,
  3. Grant Mair1,
  4. Amy Baggott2,
  5. Suvankar Pal1,2
  1. 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh
  2. 2Forth Valley Royal Hospital, Larbert

Abstract

A 59 year old right handed IT professional presented with left shoulder pain, which evolved to whole arm weakness, numbness and pain, before affecting his right arm and then legs to a lesser degree. Over subsequent weeks he developed right facial weakness and circumferential numbness around his torso. Examination revealed a mixed picture of lower motor neurone signs and long tract signs. CSF analysis showed a pleocytosis of 415 white cells, predominantly lymphocytes and elevated protein at 3.49 g/dL. MRI head showed a number of periventricular and brainstem lesions with appearances and locations typical for demyelination. Nerve conduction studies were compatible with a demyelinating polyradiculoneuropathy.

Lyme serology showed elevated IgG positive and borderline elevated IgM. His CSF antibody levels were compatible with neuroborreliosis. He was treated with ceftriaxone 4 g daily for 21 days.

The Bannwarth syndrome is a triad of painful polyradiculopathy and facial nerve palsy and lymphocytic pleocytosis, and is a presentation of neuroborreliosis typically associated with European neuroborreliosis caused by infection with Borrelia afzelii and garinii genospecies.

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