PERIPHERAL NERVOUS-SYSTEM LYME BORRELIOSIS

There are acute and chronic Lyme neuropathies. The seasonal acute synd romes of cranial neuritis or radiculoneuritis are generally quite dist inctive, 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 radiculoneuro pathies are less severe, and less distinctive. Their recognition depen ds on eliciting a history of earlier classical manifestations of Lyme disease and by laboratory testing, In both acute and chronic Lyme radi culoneuropathy, electrophysiologic testing often proves the presence o f a sensorimotor, axon loss polyradiculoneuropathy. Both acute and chr onic Lyme radiculoneuropathy have similar pathologic features and can be classified as a nonvasculitic mononeuritis multiplex. The pathogene sis is uncertain; both direct infection as well as parainfectious mech anisms may play a role. The treatment with which we have the most expe rience is intravenous ceftriaxone 2 g/day for 2 to 4 weeks. Improvemen t occurs rapidly over days to weeks in early Lyme neuroborreliosis, bu t slowly over many months in chronic neuroborreliosis.