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Neuroborreliosis, also known as Lyme neuroborreliosis (LNB), is a disorder of the central nervous system. A neurological manifestation of Lyme disease, neuroborreliosis is caused by a systemic infection of spirochetes of the genus Borrelia. Symptoms of the disease include erythema migrans and flu-like symptoms. The microbiological progression of the disease is similar to that of neurosyphilis, another spirochetal infection.

Signs and symptoms
Neuroborreliosis is often preceded by the typical symptoms of Lyme disease, which include erythema migrans and flu-like symptoms such as fever and muscle aches. Neurological symptoms of neuroborreliosis include lymphatic meningoradiculitis, cranial nerve abnormalities, and altered mental status. Sensory findings may also be present. Rarely, a progressive form of encephalomyelitis may occur. In children, symptoms of neuroborreliosis include headache, sleep disturbance, and symptoms associated with increased intracranial pressure, such as papilledema, can occur. Less common childhood symptoms can include meningitis, myelitis, ataxia, and chorea. Ocular Lyme disease has also been reported, as has neuroborreliosis affecting the spinal cord, but neither of these findings are common.

Diagnosis
A number of diseases can produce symptoms similar to those of neuroborreliosis. They include: Neuroborreliosis with symptoms consistent with amyotrophic lateral sclerosis has been described.
 * Alzheimer's disease
 * Acute disseminated encephalomyelitis
 * Viral meningitis
 * Multiple sclerosis
 * Bell's palsy

Diagnosis is determined by clinical examination of visible symptoms. Neuroborreliosis can also be diagnosed serologically to confirm clinical examination via western blot, ELISA, and PCR.

Treatment
In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross the blood–brain barrier, such as penicillins, ceftriaxone, or cefotaxime. One relatively small randomized controlled trial suggested ceftriaxone was more effective than penicillin in the treatment of neuroborreliosis. Small observational studies suggest ceftriaxone is also effective in children. The recommended duration of treatment is 14 to 28 days.

Several studies from Europe have suggested oral doxycycline is equally as effective as intravenous ceftriaxone in treating neuroborreliosis. Doxycycline has not been widely studied as a treatment in the US, but antibiotic sensitivities of prevailing European and US isolates of Borrelia burgdorferi tend to be identical. However, doxycycline is generally not prescribed to children due to the risk of bone and tooth damage.

Discreditied or doubtful treatments for neuroborreliosis include:
 * Malariotherapy
 * Hyperbaric oxygen therapy
 * Colloidal silver
 * Injections of hydrogen peroxide and bismacine

Epidemiology
Neuroborrelisosis is caused by the Borrelia burgdorferi bacterium and is a late-stage manifestation of Lyme disease, the most common vector-borne disease in the northeastern hemisphere. Subsequently, neuroborreliosis is prevalent in areas of high Lyme disease prevalence in North America and Europe.

Lymphocytic meningoradiculitis
Lymphocytic meningoradiculitis, also known as Bannwarth syndrome, is a neurological disease characterized as intense nerve pain radiating from the spine. The disease is caused by an infection of Borrelia burgdorferi, a tick-borne spirochete bacteria also responsible for causing Lyme disease.

Signs and symptoms
Lymphocytic meningoradiculitis is characterized by an intense spinal pain in the lumbar and cervical regions, radiating to the extremities. Symptoms may include facial paralysis, abducens palsy, anorexia, tiredness, headache, double vision, paraesthesia, and erythema migrans.

History
The disease was first reported in 1941 by German neurologist, Alfred Bannwarth. Bannwarth described the main symptoms as intense radicular pain, facial palsy, severe headaches, and vomiting. A common feature he observed in his infected patients patients was an abnormal increase of lymphocytes in their cerebrospinal fluid (CSF).

Alfred Bannwarth
Alfred Bannwarth (1903 – 1970) was a German neurologist who is credited for first reporting lymphocytic meningoradiculitis.

Early life and education
After first studying music, Bannwarth studied medicine graduated in Munich, Germany and later became assistant to German neurologist Max Nonne in Hamburg.

Military service
Bannwarth enlisted as a military doctor in the German military in 1945. During his service, he was stationed in the valley of Lake Tegern where he was captured by American soldiers and held prisoner until June 1946.

Related bibliography

 * Chronische lymphocytäre Meningitis, entzündliche Polyneuritis und "Rheumatismus". Ein beitrag zum Problem "Allergie und Nervensystem". Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1941, 113: 284-376.
 * Zur Klinik und Pathogenese der "chronischen lymphocytären Meningitis". Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1944, 117: 161-185, 682-716.