Cerebrospinal fluid findings in children with Lyme disease-associated facial nerve palsy
A. L. Belman, L. Reynolds, T. Preston, D. Postels, R. Grimson and P. K. Coyle
Department of Neurology, School of Medicine, State University of New York at Stony Brook, USA. abelman@neuro.som.sunysb.edu
OBJECTIVE: To determine the relative frequency of abnormal cerebrospinal
fluid (CSF) findings in children with Lyme disease-associated facial nerve
palsy. DESIGN: A clinical series. A prospective evaluation was undertaken
of the condition of children seen between 1988 and 1996 at a single medical
center in a Lyme disease endemic area. PATIENTS: Forty children (24 boys
and 16 girls, aged 3-19 years) with new onset facial nerve palsy who met
the Centers for Disease Control and Prevention case definition of Lyme
disease. INTERVENTIONS: Neurologic examinations. Cerebrospinal fluid
analysis. MAIN OUTCOME MEASURES: Rates of abnormal CSF findings: white
blood cell count, protein level, and Borrelia burgdorferi-specific CSF
assays. RESULTS: Cerebrospinal fluid white blood cell count, protein level,
or both were abnormal in 27 (68%) of the children. Thirty-six (90%) of the
40 children had a CSF abnormality consistent with central nervous system
infection or immune involvement by B burgdorferi. Of the 22 children with
CSF pleocytosis, only 7 (32%) had headache and none had meningeal signs.
CONCLUSIONS: Most children with Lyme disease-associated facial nerve palsy
have CSF abnormalities. Our studies indicate that, in endemic areas, facial
nerve palsy in children may be a marker of Lyme disease and occult
meningitis. When Lyme disease is suspected, CSF should be examined; in some
cases, it may be helpful to expand beyond routine CSF studies to look at a
battery of B burgdorferi-specific assays.
