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Cerebrospinal fluid findings in children with Lyme disease-associated facial nerve palsy.

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Abstract

OBJECTIVE:

To determine the relative frequency of abnormal cerebrospinal fluid (CSF) findings in children with
Lyme disease-associated facial nerve palsy.

DESIGN:

A clinical series. A prospective evaluation was undertaken of the condition of children seen between 1988 and 1996 at a single medical center in a
Lyme disease endemic area.

PATIENTS:

Forty children (24 boys and 16 girls, aged 3-19 years) with new onset facial nerve palsy who met the Centers for
Disease Control and Prevention case definition of
Lyme disease.

INTERVENTIONS:

Neurologic examinations. Cerebrospinal fluid analysis.

MAIN OUTCOME MEASURES:

Rates of abnormal CSF findings: white blood cell count, protein level, and Borrelia burgdorferi-specific CSF assays.

RESULTS:

Cerebrospinal fluid white blood cell count, protein level, or both were abnormal in 27 (68%) of the children. Thirty-six (90%) of the 40 children had a CSF abnormality consistent with central nervous system infection or immune involvement by B burgdorferi. Of the 22 children with CSF pleocytosis, only 7 (32%) had headache and none had meningeal signs.

CONCLUSIONS:

Most children with
Lyme disease-associated facial nerve palsy have CSF abnormalities. Our studies indicate that, in endemic areas, facial nerve palsy in children may be a marker of
Lyme disease and occult meningitis. When
Lyme disease is suspected, CSF should be examined; in some cases, it may be helpful to expand beyond routine CSF studies to look at a battery of B burgdorferi-specific assays.

Arch Pediatr Adolesc Med. 1997 Dec;151(12):1224-8. Clinical Trial; Research Support, Non-U.S. Gov’t; Research Support, U.S. Gov’t, P.H.S.

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