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 analyses.
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;151:1224-1228.