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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