Facial nerve palsy in Lyme disease: evaluation of clinical diagnostic criteria.

Objective: Lyme disease must be included in the differential diagnosis of acute facial paralysis in endemic areas. When facial nerve palsy occurs as an isolated finding, the diagnosis of Lyme disease may not be readily apparent. The goal of the present study was to evaluate the frequency with which Lyme disease could be diagnosed based on clinical symptoms alone.
Study Design and Setting: This was a retrospective chart review conducted at a tertiary hospital on Long Island, New York, an area endemic for Lyme disease.
Patients: The study population was composed of 50 patients with facial nerve palsy who were seropositive for Lyme disease (or had Lyme disease otherwise clinically proven).
Main Outcome Measures: Clinical data were initially used to classify patients as having definite, probable, or possible Lyme disease, using the surveillance criteria of the Centers for Disease Control and Prevention.
Results: In the majority of cases, the diagnosis of Lyme disease could not be made from clinical data alone. Specific findings, such as erythema migrans and meningoencephalitis, occurred only inconsistently, and serologic or cerebrospinal fluid tests were usually necessary to establish the diagnosis. Intrathecal antibody production was found in a high proportion of patients.
Conclusions: In endemic areas, Lyme disease should be suspected as a cause of acute facial nerve palsy even in the absence of other clinical symptoms. Cerebrospinal fluid serology is helpful in confirming the diagnosis and planning therapy. Central nervous system infection may be common in Lyme disease facial nerve palsy.