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Cerebrospinal Fluid Findings in Children With Lyme Disease-Associated Facial Nerve Palsy

Anita L. Belman, MD; L. Reynolds, MD; T. Preston, PhD; D. Postels, MD; R. Grimson, PhD; P. K. Coyle, MD
Arch Pediatr Adolesc Med. 1997;151(12):1224-1228. doi:10.1001/archpedi.1997.02170490050009.
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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.


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