Symptoms of neuroborreliosis

introduction

Neuroborreliosis is a condition of borreliosis, a bacterial infection that is transmitted by a tick bite. Acute neuroborreliosis occurs primarily in stage 2 of borreliosis, i.e. weeks to months after the tick bite. The neurological symptoms are often the first to be noticed and lead to the diagnosis of Lyme disease, because not every patient can remember a tick bite. Neuroborreliosis can manifest itself in a variety of ways, and the diagnosis is often not easy. To diagnose neuroborreliosis, you need a sample of the nerve water (liquor), which can be obtained by puncturing the spinal cord. MRI imaging is also performed.

For more information on the underlying diseases, see Lyme disease.

Symptoms of neuroborreliosis

The term neuroborreliosis generally refers to a stage of Lyme disease infection in which neuronal structures, i.e. the skeleton, the meninges, the spinal cord or nerve cords are affected by the infection. In the following, the possible clinical symptoms of acute neuroborreliosis are listed in descending order of frequency. Some of the symptoms are more likely to be associated with chronic neuroborreliosis.

Headache and fever

In the second stage of Lyme disease, there is initially a strong feeling of illness with tiredness, fever and headache. The symptoms resemble a flu-like infection and are very unspecific, which is why the diagnosis of neuroborreliosis is usually not easily made at this point in time.

Symptoms of nerve root inflammation

The typical appearance of a nerve root inflammation is the so-called Bannwarth syndrome. It usually occurs about 4-6 weeks after the tick bite. Among other things, one or more nerve roots in the spinal cord become inflamed. There is strong belt-like pain, which occurs mainly at night. The complaints usually begin near the original tick bite. The pain emanating from the nerve root, generally also called "radicular pain"respond poorly to conventional pain relievers.
Furthermore, the pain can be accompanied by flaccid paralysis, although sensory disturbances such as tingling feelings rarely occur. The symptom complex of Bannwarth syndrome also includes other symptoms such as cardiac muscle inflammation, joint problems, lymph node swelling and cranial nerve inflammation (60% of cases).

Please also read our article on this Nerve root inflammation.

Facial palsy

The facial muscle nerve, the facial nerve, is affected by a facial parest. The patients then typically complain of a sagging half of the face, the corner of the mouth drooping and it is not possible to completely close the eyes. Facial paralysis in the context of neuroborreliosis usually regresses in 1-2 weeks.

Read more on this topic at: Facial palsy

Eye muscle paralysis

Similar to the facial muscle nerve in facial paralysis, the nerve that supplies the eye muscles can also be affected by neuroborreliosis. In this case, certain eye muscles are paralyzed, which disrupts the finely tuned interaction between the two eyeballs. This typically leads to the formation of double images. A restricted direction of movement of an eye becomes visible to the examiner.

Please also read our article on this Eye muscle paralysis.

Signs of paralysis

Neuroborreliosis can also lead to paralysis of the limbs. These are usually flaccid paralysis that occurs unsystematically and asymmetrically. This means that the respective limb is only affected on one side. The paralysis usually regresses by itself.

Sensory disturbances ("tingling")

Neuroborreliosis can also damage sensitive nerves, which include are responsible for the sensation in the limbs. This can lead to so-called sensitivity disorders, with the patients usually reporting a "tingling sensation" in the affected area. This phenomenon, too, usually regresses on its own.

Meningitis symptoms

The meninges can also be affected by neuroborreliosis. However, these are not inflamed with purulent inflammation, as is the case with classic bacterial meningitis. Borreliosis meningitis occurs more in the context of chronic neuroborreliosis (i.e. in Stage 3). In addition to the meninges, the brain tissue or the spinal cord are often also affected by the inflammation, which is known in technical terms as Enzphalomyelitis or. Meningoencephalitis designated. Depending on where the focus of inflammation is, the symptoms are quite different.

For details, see Symptoms of meningitis.

Impaired consciousness

Disturbances in consciousness are among the symptoms of acute meningitis. The patients then appear to their environment absent, apathetic and otherwise behavioral and deprived of consciousness. With neuroborreliosis in adulthood, however, this is not one of the typical symptoms, but fortunately only occurs in rare cases.

Speech disorders

Speech disorders rarely occur in the context of acute neuroborreliosis. They arise when the inflammation spreads to the brain tissue and affects the areas that control speech. Speech disorders can also occur in the context of chronic neuroborreliosis.

You can find an overview of language disorders and their causes under Speech disorder.

Incontinence

Incontinence is a rather rare symptom of neuroborreliosis. It arises from damage to the nerves responsible for emptying the bladder, or to their roots in the spinal cord area, when the inflammation spreads to the spinal cord.

For more information, see Incontinence.

Symptoms of chronic neuroborreliosis

Chronic neuroborreliosis develops in only 5% of neuroborreliosis patients and is present if the symptoms have persisted for more than 6 months. The chronic form is the Stage 3 associated with Lyme disease. The inflammation of the meninges and the brain is typical of chronic neuroborreliosis (Meningoencephalitis), as well as the spinal cord (Myelitis).
In this case, this disease is unfortunately progressive and does not resolve itself again. Permanent damage to the brain structures often occurs. In addition, localized inflammation of the vessels in the brain (cerebral vasculitis) rarely occurs.
The symptoms that the affected patients have as a result of these changes in the brain are very different. Paralysis of the limbs and cranial nerve failure, e.g. facial paralysis (see above), occur most frequently. In chronic neuroborreliosis, however, the paralysis persists. Sensitivity disorders, unsteady gait and bladder dysfunction can also be symptoms. Furthermore, personality changes and neuropsychiatric disorders (headache, attention problems, impaired memory function, depression, etc.) are described. Patients with chronic neuroborreliosis often also suffer from other chronic symptoms of borreliosis, such as joint inflammation (arthritis) and skin involvement.

Difficulty concentrating and listlessness

Particularly in the context of chronic neuroborreliosis, it can lead to concentration disorders and listlessness. In this context one speaks of the organic psychosyndrome. Concentration disorders are, for example, also a typical syndrome of depression that can occur in the advanced stage of neuroborreliosis.

You can also find detailed information on this symptom under Poor concentration.