Involvement may reflect:
(1) meningitis
(2) encephalitis or encephalomyelitis
(3) meningoencephalitis
(4) leukoencephalitis
Clinical findings:
(1) cognitive impairment, ranging from mild to a dementia
(2) psychiatric problems (anxiety, depression, irritability)
(3) impaired level of consciousness
(4) cranial neuritis (facial palsy, CN VIII, other)
(5) radiculoneuritis, mononeuritis multiplex or peripheral neuropathy
(6) chronic fatigue
(7) headaches
(8) autonomic dysfunction
(9) spastic paraparesis
(10) ataxia
(11) urinary incontinence
(12) sleep disturbances
(13) difficulty with understanding speech or with speaking
Laboratory findings:
(1) variable lymphocytic pleocytosis in the CSF
(2) serologic changes (see previous section)
The presence of meningitis, cranial neuritis and radiculoneuritis is a triad that is highly suggestive of neuroborreliosis.
The diagnosis is usually straightforward if there are other manifestations of Lyme disease (history of tick bite, skin rash, arthritis, etc) but can be difficult if these are absent. The presence of these neurologic findings may justify testing for Lyme disease if no other explanation is evident.
