Objective:

Neuroborreliosis neurological manifestations include facial nerve palsies, meningitis and radiculoneuritis. We present a rare case of elevated intracranial pressure as a manifestation of neuroborreliosis in an adult female.

Background:

A 26-year-old female presented with intractable headches for 1 month associated with transient blurred vision, nausea and neck stiffness.  On examination was found to have bilateral grade 2 papilledema.  MRI brain within normal, LP performed with an opening pressure of 40 cmH2O,  WBC of 23 with lymphocytic predominance and normal CSF protein and glucose. The patient was initiated on acetazolamide with diffrential of idiopathic intracranial hypertension.   One week later the patient developed sudden onset right lower motor neuron facial paresis and severe lower back pain. On further history taking, the patient revealed that she had traveled to Northern Michigan three months prior with cases of lyme disease reported in the area. The patient was initiated on IV ceftriaxone.  After the second dose of IV ceftriaxone the patient reported improvement in her headache with neurological examination demonstrating improvement in facial nerve paresis. The patient was subsequently transitioned to oral doxycycline and discharged. Post discharge Lyme Western blot resulted positive. On follow up, the patient had complete resolution of her symptoms.

Design/Methods:

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Results:

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Conclusions:

We highlight a case of raised intracranial pressure in an adult female in association with Lyme disease.  per literature, raised intracranial pressure has been found with Lyme disease in the pediatric population. In our case an adult female presented with symptoms associated with raised intracranial pressure in the setting of Lyme disease.    In the case highlighted, classic manifestation of CNS Lyme disease appeared after symptoms of raised intracranial pressure arose leading to an initial misdiagnosis of idiopathic intracranial hypertension. The patient's symptoms drastically improved with the appropriate  antibiotic therapy.