Campbell J, et al

A 39-year old man with facial diplegia

Teaching NeuroImagesNeurology

Resident and Fellow Section

© 2013 American Academy of Neurology

Case History

• A 39-year-old man presented with progressive facial diplegia and mild headache.

• He reported a self limited, migratory rash three weeks previously following a walk in Castlewellan forest park in Northern Ireland.

• CSF revealed 356 lymphocytes/µL, Protein 2.64g/L with normal glucose.

• MRI brain imaging was performed

Campbell J, et al

Figure 1 MRI brain showing multiple cranial nerve involvement

Campbell J, et al

Figure 2 MRI brain showing multiple cranial nerve involvement

Campbell J, et al

Facial diplegia due to neuroborreliosis.

• Serology was positive for Borellia antibodies.• Clinical manifestations of neuroborreliosis may include

meningitis, cranial neuropathies and radiculoneuritis. • MRI brain can show enhancement of multiple cranial

nerves1. • This patient was symptomatic only of facial nerve

involvement. • Treatment is with oral Doxycycline or IV cephalosporin.• Our patient made a full recovery following the

completion of a course of IV ceftriaxone2.

Campbell J, et al