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Lyme Bilateral Facial Palsy — SCE Infectious Diseases MCQ

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HardCNS InfectionLyme Bilateral Facial PalsySCE Infectious Diseases

A previously well adult develops bilateral lower-motor-neurone facial palsies three weeks after a tick bite in the Scottish Highlands. Which diagnosis should be investigated?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: DEarly disseminated Lyme neuroborreliosis after a compatible tick exposure

The best answer is “Early disseminated Lyme neuroborreliosis after a compatible tick exposure”. Bilateral facial palsy is a characteristic neurological Lyme presentation; exposure history supports serology and neurological assessment, with CSF testing when neuroborreliosis is suspected. Compatible tick exposure with bilateral facial palsy or other neurological features prompts Lyme serology and neuroborreliosis assessment and treatment.

Reference: NICE NG95: Lyme disease: https://www.nice.org.uk/guidance/ng95/chapter/Recommendations