Peripheral nervous system Lyme borreliosis.

 Semin Neurol. 1997 Mar;17,1:25-30.Peripheral nervous system Lyme borreliosis.
Logigian EL.
Harvard Medical School, Clinical Neurophysiology Laboratory, Brigham and Women's Hospital, 
Boston, Massachusetts 02115, USA.
There are acute and chronic Lyme neuropathies. The seasonal acute syndromes of cranial neuritis 
or radiculoneuritis are generally quite distinctive, but may cause diagnostic difficulty when one 
syndrome occurs without the other, when erythema migrans is absent or missed, and when 
meningeal signs are minimal or absent. The chronic Lyme radiculoneuropathies are less severe, 
48and less distinctive. Their recognition depends on eliciting a history of earlier classical 
manifestations of Lyme disease and by labor atory testing. In both acute and chronic Lyme 
radiculoneuropathy, electrophysiologic testing often proves the presence of a sensorimotor, axon 
loss polyradiculoneuropathy. Both acute and chronic Lyme radiculoneuropathy have similar 
pathologic features and can be classified as a nonvasculitic mononeuritis multiplex. The 
pathogenesis is uncertain; both direct infection as well as parainfectious mechanisms may play a 
role.The treatment with which we have the most experience is intravenous ceftriaxone 2 g/day 
for 2 to 4 weeks. Improvement occurs rapidly over days to weeks in early Lyme 
neuroborreliosis, but slowly over many months in chronic neuroborreliosis

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