Background

It is extremely rare for Lyme borreliosis to present solely with features of increased intracranial pressure. The treatment of pediatric Lyme neuroborreliosis with oral versus intravenous antibiotics remains controversial.

Case

A 13-year-old male presented with 5 days of binocular diplopia, several weeks of headache, and a history of multiple tick bites 6 weeks prior. His exam showed a left eye abduction deficit and bilateral optic disc edema. MRI brain with contrast showed tortuosity of the optic nerves, prominence of the optic nerve sheaths and enhancement of the left 5th and bilateral 6th cranial nerves. Lumbar puncture showed an elevated opening pressure and a lymphocytic pleocytosis. Lyme IgM and IgG antibodies were positive in the serum and CSF. The patient was treated with ceftriaxone IV for 2 days empirically followed by doxycycline PO for 19 days. Symptoms began improving after 48 hours. The strabismus resolved after 2 weeks and the papilledema improved slowly with complete resolution at 6 months.

Conclusions

Lyme neuroborreliosis can present as isolated intracranial hypertension in the pediatric population. It can be differentiated from idiopathic intracranial hypertension on MRI and lumbar puncture and can be confirmed with serum antibody testing. Oral doxycycline can be considered for Lyme neuroborreliosis in children.

中文翻译：

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单纯性颅内高压作为小儿莱姆疏螺旋体病的表现：病例报告和文献综述

背景

莱姆疏螺旋体病仅表现为颅内压增高的特征极为罕见。口服抗生素与静脉注射抗生素治疗儿童莱姆神经疏螺旋体病仍存在争议。

案件

一名 13 岁男性出现 5 天的双眼复视、数周的头痛以及 6 周前多次蜱虫叮咬史。他的检查显示左眼外展缺陷和双侧视盘水肿。脑部 MRI 对比显示视神经迂曲，视神经鞘突出，左侧第 5 脑神经和双侧第 6 脑神经增强。腰椎穿刺显示开放压升高和淋巴细胞增多。血清和脑脊液中莱姆病 IgM 和 IgG 抗体呈阳性。该患者接受头孢曲松 IV 经验性治疗 2 天，随后口服多西环素 19 天。48 小时后症状开始改善。两周后斜视得到缓解，视乳头水肿缓慢改善，并在 6 个月时完全缓解。

结论

莱姆神经疏螺旋体病在儿科人群中可表现为孤立性颅内高压。MRI和腰椎穿刺可与特发性颅内高压鉴别，并可通过血清抗体检测确诊。口服多西环素可考虑治疗儿童莱姆神经疏螺旋体病。