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