Abstract
The objective of the study is to report the first case of isolated trochlear palsy secondary to Lyme neuroborreliosis in an adult. A 22-year-old male presented with history of flu-like illness and headache, accompanied by vertical binocular diplopia, worse on downgaze and better in upgaze and right head tilt. Physical examination revealed trochlear palsy on the left side with a compensatory head tilt to the opposite side. A subsequent workup for trochlear palsy was conducted, including hematological and cerebral spinal fluid serum studies, and magnetic resonance imaging of the brain. Immunoglobulin (Ig)M and IgG antibodies against Borrelia burgdorferi were positive in serum and cerebral spinal fluid (CSF). Symptoms of double vision completely resolved after 3 weeks of antibiotic treatment with intravenous ceftriaxone. CSF studies, in addition to clinical symptoms of vertical double vision and a positive Parks 3-step test, are a good diagnostic tool for B. burgdorferi. Resolution of symptoms was noted after a complete course of intravenous ceftriaxone.
References
Ljostad U, Mygland A (2008) Lyme borreliosis in adults. Tidsskr Nor Laegeforen 128(10):1175–1178
Lopez-Alberola RF (2006) Neuroborreliosis and the pediatric population: a review. Rev Neurol 42(Suppl 3):S91–S96
Czupryna P, Kusmierczyk J, Zajkowska JM et al (2007) Clinical forms of neuroborreliosis among hospitalized patients in the years 2000–2005. Pol Merkur Lekarski 23(134):103–106
Marsot-Dupuch K, Gallouedec G, Bousson V et al (2000) Facial palsy, enhancement of cranial nerves and Lyme disease. J Radiol 81(1):43–45
Khalil M, Boncoeur MP, Torny F et al (2003) Cranial neuritis with enhancement on post-contrast MRI due to Lyme disease. Rev Neurol (Paris) 159(3):329–331
Lell M, Schmid A, Stemper B et al (2003) Simultaneous involvement of third and sixth cranial nerve in a patient with Lyme disease. Neuroradiology 45(2):85–87
Zrinscak O, Masnec-Paskvalin S, Corak M et al (2005) Paralytic strabismus as a manifestation of lyme borreliosis. Coll Antropol 29(Suppl 1):137–139
Iero I, Elia M, Cosentino FI et al (2004) Isolated monolateral neurosensory hearing loss as a rare sign of neuroborreliosis. Neurol Sci 25(1):30–33
Ishizaki H, Pyykko I, Nozue M (1993) Neuroborreliosis in the etiology of vestibular neuronitis. Acta Otolaryngol Suppl 503:67–69
Muller D, Neubauer BA, Waltz S, Stephani U (1998) Neuroborreliosis and isolated trochlear palsy. Eur J Paediatr Neurol 2(5):275–276
Christen HJ, Hanefeld F, Eiffert H, Thomssen R (1993) Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl 386:1–75
Huber A, Baumann W (1989) Clinical manifestation of Lyme borreliosis in childhood. Klin Padiatr 201(2):133–135
Pfister HW (1999) Diagnosis and therapy of Lyme neuroborreliosis. Ther Umsch 56(11):664–669
Kodsi SR, Younge BR (1992) Acquired oculomotor, trochlear, and abducent cranial nerve palsies in pediatric patients. Am J Ophthalmol 114(5):568–574
Tiffin PA, MacEwen CJ, Craig EA, Clayton G (1996) Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye 10(Pt 3):377–384
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bababeygy, S.R., Quiros, P.A. Isolated trochlear palsy secondary to Lyme neuroborreliosis. Int Ophthalmol 31, 493–495 (2011). https://doi.org/10.1007/s10792-011-9482-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-011-9482-4