A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology.

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A 39-year old man with facial diplegia Teaching NeuroImages Neurology Resident and Fellow Section Campbell J, et al © 2013 American Academy of Neurology

Case History A 39-year-old man presented with progressive facial diplegia and mild headache. He reported a self limited, migratory rash three weeks previously following a walk in Castlewellan forest park in Northern Ireland. CSF revealed 356 lymphocytes/µL, Protein 2.64g/L with normal glucose. MRI brain imaging was performed Campbell J, et al

Figure 1 MRI brain showing multiple cranial nerve involvement Campbell J, et al

Figure 2 MRI brain showing multiple cranial nerve involvement Campbell J, et al

Facial diplegia due to neuroborreliosis. Serology was positive for Borellia antibodies. Clinical manifestations of neuroborreliosis may include meningitis, cranial neuropathies and radiculoneuritis. MRI brain can show enhancement of multiple cranial nerves 1. This patient was symptomatic only of facial nerve involvement. Treatment is with oral Doxycycline or IV cephalosporin. Our patient made a full recovery following the completion of a course of IV ceftriaxone 2. Campbell J, et al