ISOLATED FASCICULAR ABDUCENS NERVE PALSY AND LYME-DISEASE

A patient with Lyme disease developed an isolated sixth nerve palsy at the end of a 1 month course of oral antibiotics. Magnetic resonance i maging disclosed high-signal abnormality at the left pontomedullary ju nction, implicating involvement of the distal sixth nerve fascicle. Al though facial numbness ensued during a subsequent course of intravenou s antibiotics, corticosteroid therapy was associated with prompt impro vement of neurologic signs, suggesting an immunologic mechanism for th e central nervous system dysfunction.