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Published on: February 4, 2018
Papilledema Secondary to Neurologic Lyme Borreliosis: A Meta-Case Series
Elizaveta E Vaysbrot1, Raveendhara R Bannuru, Mia-Cara Christopher
1Center for Treatment Comparison and Integrative Analysis (CTCIA) (EEV, RRB, M-CC, MCO), Tufts Medical Center, Boston, Massachusetts; and Department of Neurosciences (JJH), Overlook Hospital, New York University School of Medicine, Summit, New Jersey.
Background:
Papilledema can be a manifestation of neurologic Lyme borreliosis (LB). The clinical manifestations and progression of these cases have not been comprehensively documented to date. We aimed to describe clinical and diagnostic features and to assess patient outcomes in cases of papilledema secondary to neurologic LB.
Methods:
We searched MEDLINE, EMBASE, and the Cochrane Database from inception to August 2019. We did not restrict our search by study design or by publication date, status, or language.
Results:
Twenty-eight studies describing 46 cases of papilledema secondary to neurologic LB were included. Common clinical features included cranial neuropathy (68%) and diplopia (61%). Most patients did not recall tick bite (71%) and were afebrile (74%). Brain imaging was normal in 64% cases. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (77%). Initial treatment with intravenous ceftriaxone was given in 52% of cases and resulted in a 100% resolution rate. Concomitant treatment with acetazolamide resulted in favorable outcomes.
Conclusions:
For patients in endemic regions who describe symptoms suggestive of intracranial hypertension and papilledema, especially accompanied by facial nerve palsy and other cranial nerve palsies, underlying neurologic LB should be considered.
