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Lyme neuroborreliosis — SCE Neurology MCQ

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ModerateCNS InfectionsLyme neuroborreliosisSCE Neurology

A 55-year-old develops painful radiculopathy, bilateral lower motor neurone facial palsies and lymphocytic meningitis several weeks after a tick bite. Initial serum Lyme serology is positive but diagnosis remains uncertain. Which investigation best supports a diagnosis of Lyme neuroborreliosis?

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Correct answer: A — Paired serum and CSF testing to assess intrathecal Borrelia-specific antibody production

For suspected neurological Lyme disease, UKHSA advises paired serum and CSF testing with assessment for intrathecal Borrelia-specific antibody production. CSF PCR has limited sensitivity and must not be relied upon as the sole test, particularly after treatment.

Reference: UKHSA, Lyme disease: sample testing advice: https://www.gov.uk/guidance/lyme-disease-sample-testing-advice