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Special implementations regarding neuroborreliosis

Neuroborreliosis is a consequence of a disseminated (systemic) infection with borrelia burgdorferi with participation of the central nervous system.

Important: approx. 50% of all tick bites go unnoticed! Only approx. 60% to 70% of those infected develop erythema migrans, a typical early symptom for the disease.

Clinical picture/symptoms

Meningo polyneuritis, polyradiculitis (Garin-Bujadoux-Bannwarth syndrome)
Weeks until months after infection (tick bite!)

  • Burning radicular pain (mononeuritis)
  • Asymmetric sensitivity disturbances
  • Signs of paralysis, often involving the cranial nerve
  • Often localised close to the tick bite (anamnesis!)

DD: among others Radicular compression syndrome (slipped disc)

Possible consequences of an undiagnosed case of radiculitis due to borrelia are constant pain symptoms, paraesthesia, temperature sensation disorders and pain sensation disorders.

Cranial nerve paresis
Weeks until months after infection (tick bite!)
Affected cranial nerves: 

  • N. facialis (common, often as diplegia facialis)
  • N. abducens (rare)
  • N. occulomotorius, n. opticus (very rare)

Differential diagnoses are to be taken into consideration: Bleeding, vessel occlusion, tumour, multiple sclerosis, neurolues

Encephalitis, myelitis 
are later consequences of a borrelia infection. The symptoms are very diverse:

  • Cranial nerve paresis
  • Gait disorder
  • Paraparesis or tetraparesis
  • Urination disorders
  • Epilepsy
  • Changes in behaviour
  • Dementia
  • Sleep disorders
  • Concentration disorders
  • Chronic fatigue
  • Hallucinations (psychosis)

The differential diagnosis needs to take multiple sclerosis, neurolues and virus infections (for example: FSME).

Laboratory diagnosis of neuroborreliosis

Fluid/blood:

  1. Screening test (EIA for IgG and IgM antibodies) for antibodies against borrelia
  2. The Immunoblot borrelia kit allows us to identify borrelia-specific IgG and IgM antibodies against the various surface proteins of borrelia (note: the borrelia recomBead Test is currently only available for serum and not for fluid).
  3. In cases where the serology diagnosis is unclear, then clarification using a lymphocyte transformation test (LTT - borrelia) should be sought.

Fluid:

  1. Cell number in fluid (preanalytics: Analysis within 1-2 hours after collecting fluid)
  2. Total protein (fluid)
  3. Albumin quotient (fluid/serum)
  4. Q-IgG, Q-IgM, Q-IgA (fluid/serum)
  5. Oligoclonal bands (fluid/serum)
  6. antibodies against borrelia burgdorferi (specificity index of antibodies - "ASI") fluid/serum

Typical fluid findings in neuroborreliosis

  1. Slightly increased cell number
  2. Increased total protein
  3. Albumin quotient: Light to medium functional disorder of the blood-fluid barrier.
  4. Q-IgG, Q-IgM, Q-IgA: Intrathecal synthesis (3-class response) with IgM antibody dominance
  5. Oligoclonal bands only partially identified
  6. Borrelia burgdorferi - ASI: Proof of a intrathecal antibody synthesis towards B. burgdorferi

An interpretation of the laboratory report follows, taking into consideration the patient's clinical and anamnestic information received from the treating physician.

Data regarding the sensitivity and specificity of the lymphocyte transformation test in neuroborreliosis are not available yet.