[Neuroborreliosis--a diagnosis easily overlooked]

Area of Science:

• Neurology
• Infectious Diseases
• Medical Diagnostics

Background:

• Neuroborreliosis is a frequent complication of untreated erythema migrans, a tick-borne illness.
• Early diagnosis and treatment are crucial to prevent neurological sequelae.
• The presentation of neuroborreliosis can be varied and sometimes subtle.

Observation:

• Two patient case histories with confirmed neuroborreliosis are presented.
• In both cases, the primary presenting symptom was pain, which did not initially suggest a neuroinfection.
• Cerebrospinal fluid analysis revealed pleocytosis and Borrelia antibodies, confirming the diagnosis.

Findings:

• Intravenous penicillin therapy was curative in both documented cases.
• The diagnostic confirmation relied on cerebrospinal fluid examination for pleocytosis and specific antibodies.
• Isolated pain as a neurological symptom can be indicative of neuroborreliosis.

Implications:

• Clinicians should consider neuroborreliosis in patients with a history of erythema migrans presenting with neurological symptoms, including isolated pain.
• Lumbar puncture is a recommended diagnostic procedure in suspected cases, even when pain is the sole neurological manifestation.
• Prompt diagnosis and appropriate antibiotic treatment, such as intravenous penicillin, are effective in managing neuroborreliosis.