Facial Palsy occurs during the “Early Disseminated” Stage of Lyme
STAGES OF LYME DISEASE — from time of tick exposure
Early Localized (1-4 wks)- Erythema Migrans (EM) lesion(s) [see pix below]
- Generalized arthralgias, myalgias, fatigue, malaise, “viral syndrome”
- Migratory Arthralgias
- Multiple EM lesions
- Meningeal Sx
- Cranial Nerve Palsies (esp. facial nerve)
- Radiculopathy / Peripheral neuropathy
- Cerebellar Ataxia
- Carditis (A-V Block, often asymptomatic)
- Mono- / Oligo-arthritis
- Neuro: Subtle cognitive deficits, paresthesias, radiculopathy (not CN7 Palsy)
EPIDEMIOLOGY
Vast Majority of cases: VA (northern tip), MD, DL, NJ, PA, NY (eastern), New England, Wisc, Minn.- Forested areas
- Also suburbs of Boston, NYC, Phila
- Most pts don’t notice tiny nymph ticks
- CN7 Palsy occurs weeks to months after bite
DIAGNOSIS — Antibodies to Borrelia burgdorferi (ELISA / IFA; Western Blot)
Early Localized — EM lesion(s)- Serology negative
- If negative = No Lyme Disease
-
If positive: confirm with Western Blot IgM and IgG
- IgM is diagnostic
- If negative = No Lyme Disease
- If positive: confirm with Western Blot IgG
- Serology only useful for specific clinical symptoms
- EM lesions (rash is diagnostic: just Tx)
- Arthralgias / myalgias without other symptoms of Early Disseminated Disease
- Screen asymptomatic people
- Note that early lesions may be small & subtle
Multiple EM Lesions [approx. 20% or pts]