Introduction
Neuroborreliosis is an appearance of Lyme disease, a bacterial infection transmitted by a tick bite. Acute neuroborreliosis occurs mainly in the so-called stage 2 of Lyme disease, i.e. weeks to months after the tick bite. Often the neurological symptoms are the first to be noticed and lead to the diagnosis of Lyme disease, because not every patient can remember a tick bite.
The neuroborreliosis can appear in many different ways, the diagnosis is often not easy. To diagnose a neuroborreliosis, a sample of the nerve water (liquor) is needed, which can be obtained by puncturing the spinal cord. In addition, an imaging by means of MRI is performed.
Symptoms of neuroborreliosis
The term neuroborreliosis generally describes a stage of Lyme disease infection in which neuronal structures, i.e. the gerhin, the meninges, the spinal cord or nerve cords are affected by the infection. In the following, the possible clinical symptoms of acute neuroborreliosis are listed in descending order of frequency. Some of the symptoms are more likely to be associated with chronic neuroborreliosis.
Headache and fever
In the 2nd stage of Lyme disease, the first symptom is a strong feeling of illness with tiredness, fever and headaches. The symptoms resemble a flu-like infection and are very unspecific, which is why the diagnosis of a neuroborreliosis is usually not made at this stage without further ado.
Symptoms of nerve root inflammation
The typical appearance of an inflammation of the nerve root is the so-called Bannwarth syndrome. It appears about 4-6 weeks after the tick bite. Among other things, one or more nerve roots of the spinal cord become inflamed.
Strong belt-like pain develops, which occurs mainly at night. The symptoms usually start near the original tick bite. The pain emanating from the nerve root, generally referred to as “radicular pain“, responds poorly to conventional painkillers.
Furthermore, the pain can be accompanied by flaccid paralysis, whereby sensitivity disorders such as tingling sensations occur rather rarely. Other symptoms of Bannwarth syndrome include myocarditis, joint pain, swelling of lymph nodes and inflammation of the cranial nerves (60% of cases). The facial muscle nerve, the facial nerve, is affected by facial paresis.
Patients typically complain of a flabby half of the face, the corner of the mouth hangs down and the eyes cannot be completely closed. Facial nerve palsy in the context of neuroborreliosis usually resolves within 1-2 weeks. Similar to the facial muscle nerve in facial paresis, the nerve that supplies the eye muscles can also be affected by neuroborreliosis.
In this case, paralysis of certain eye muscles occurs, disrupting the finely tuned interaction of the two eyeballs. Typically, this results in the formation of double images. For the examiner, a restricted direction of movement of one eye becomes visible.
In the context of neuroborreliosis, paralysis of the limbs can also occur. These are usually flaccid paralyses that occur unsystematically and asymmetrically. This means that the respective limb is only affected on one side.
The paralysis usually recedes of its own accord. Neuroborreliosis can also damage sensitive nerves, which are responsible for sensation in the limbs, among other things. This can lead to so-called sensory disturbances, whereby patients usually report a “tingling sensation” in the affected area. This phenomenon, too, usually recedes on its own.
All articles in this series:
