Bilateral Vestibulopathy in Neuroborreliosis

To describe a unique case of definite neuroborreliosis presenting with bilateral vestibulopathy (BV) due to simultaneous involvement of both vestibular systems highlighted by a complete assessment for all five vestibular receptors.

A 72-year-old woman presented with disabling disequilibrium arisen about 4 weeks earlier and history of erythema migrans developing about 45 days before.

Assessing all five vestibular receptors with the video-head impulse test (vHIT), the suppression head impulse paradigm (SHIMP) and vestibular evoked myogenic potentials (VEMPs), a severe bilateral vestibulopathy was diagnosed. IgG and IgM Borrelia-specific antibodies on patient serum and cerebrospinal fluid analysis confirmed the diagnosis of neuroborreliosis. Following diagnosis, a course of doxycycline was started and the patients received an individualized vestibular rehabilitation program.

The patient exhibited slowly progressive improvements for disabling symptoms and the improving function of all five vestibular receptors was monitored with vHIT, SHIMP, and VEMPs over time.

This is the first case report of bilateral vestibulopathy likely caused by neuroborreliosis. Although neurotologic involvement is an uncommon complication in this condition, clinicians should consider a vestibular testing battery when addressed by patient's history and bedside vestibular findings.