Classic neurologic triad of early disseminated Lyme disease

Q: What is the classic neurologic triad of early disseminated Lyme disease?

Answer: Although it may not always present as a triad, in classic cases, the triad consists of:

• meningitis
• cranial neuropathy
• motor or sensory radiculoneuropathy

The common neurologic features of early disseminated Lyme disease may include one or all of:

• Lymphocytic meningitis
• Unilateral or bilateral* cranial nerve palsies (mostly facial nerve)
• Radiculopathy
• Peripheral neuropathy
• Mononeuropathy multiplex
• Cerebellar ataxia 
• Encephalomyelitis 

Although the facial nerve is the most commonly affected cranial nerve, other nerves such as the abducens nerve may be involved.

*Lyme disease is one of the few causes of bilateral cranial nerve palsies, along with tuberculosis, sarcoidosis, and trauma. 

#neurology

References:

1. Halperin JJ. Nervous system Lyme disease. Infect Dis Clin North Am 2008; 22:261.

2. Sauer A, Hansmann Y, Jaulhac B, et al. Five cases of paralytic strabismus as a rare feature of lyme disease. Clin Infect Dis 2009; 48:756.

3. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1.