Sudden facial paralysis could be a hidden sign of Lyme disease, experts warn

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Lyme disease can attack the body comprehensively and its symptoms are often mistaken

Experts warn that Lyme disease, transmitted by ticks, is a serious threat that should not be disregarded. This disease has many forms and can affect the skin, joints and the nervous system. Neuroborreliosis, the most insidious form of the disease, is often difficult to diagnose.

Neuroborreliosis symptoms are not just limited to headaches or concentration problems, but may also resemble symptoms of meningitis or sudden facial nerve paralysis. This often affects the VII nerve, causing a sudden drop in one side of the patient's mouth.

Interestingly, Lyme disease can present itself either through distinct erythema or rather subtly, with no outward signs. Therefore, if you or a loved one notices unexpected neurological symptoms, do not put off visiting a doctor.

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Neuroborreliosis can be challenging to diagnose because the Borrelia burgdorferi bacteria can lie dormant in our bodies and potentially attack years after a tick bite. Consequently, many people do not link sudden neurological symptoms to a tick bite they may have previously overlooked.

Facial nerve paralysis: a possible symptom of Lyme disease

Lyme disease infection in humans can present itself as neuropathy of the cranial nerves. Paralysis often starts suddenly and while any nerve can be affected, it most often involves the VII nerve.

Typically, in neuroborreliosis, facial nerve paralysis can be triggered by inflammation at the base of the temporal lobes. Peripheral paresis is also possible, which can occur alongside migratory erythema, a common sign of Lyme disease, but it doesn't necessarily happen with each case.

Doctors have identified that diagnosing neuroborreliosis can be very complex as nervous system damage can take place shortly after bacterial infection or several months, even many years later, post exposure to a tick bite.

Many people who experience facial nerve paralysis do not associate this symptom with a tick bite and instead, predominantly link it to a stroke.

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Patients may also experience root syndrome or cranial nerve palsies with mild or nonexistent meningeal symptoms. This often leads to treatments that address the symptoms like root nerve inflammation or VII nerve paralysis, without diagnosing and treating the true cause of the problems, which is Lyme disease.

When is neuroborreliosis diagnosed?

According to the latest guidelines from the European Federation of Neurological Societies (EFNS), a diagnosis of neuroborreliosis affecting the central nervous system can be made if three conditions are fulfilled:

• Presence of neurological symptoms suggesting neuroborreliosis, after ruling out other causes,

• Detection of pleocytosis in cerebrospinal fluid,

• Confirmation of intrathecal synthesis of antibodies against Borrelia burgdorferi.

However, meeting only two of these criteria still allows for a probable diagnosis of neuroborreliosis.

Furthermore, magnetic resonance imaging (MRI) or computed tomography (CT) scans are performed in patients suspected of having vascular inflammation and its potential outcomes such as ischemic stroke, as well as when a nerve root inflammation is suspected.