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Georg Hagemann, MD; Ilia Mois Aroyo, MD

Arch Neurol. 2009;66(4):534-535.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A 54-year-old forest worker experienced bilateral facial weakness. A few days later, he presented with an almost complete facial palsy without any disturbances of taste, hearing, or sensation. He had a marked Bell phenomenon (Figure). He was diagnosed some years before with Lyme disease without any clinical symptoms and was treated with oral antibiotics. Meanwhile, he received some new tick bites. A lumbar puncture revealed a lymphocyte count of 77/µL and an elevated protein level of 2.5 g/L. Serological testing revealed positive IgG results, a negative IgM borreliosis titer on an enzyme-linked immunosorbent assay, and multiple bands on Western blotting, suggestive of either remnants of an earlier asymptomatic contact with borrelia or a late or very recent infection with still-absent IgM antibodies. In cerebrospinal fluid, IgM antibodies were negative and the IgG antibody index was 1.4. Serological testing results for tick-borne . . . [Full Text of this Article]

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