A diagnostic algorithm for children presenting with peripheral facial nerve palsy and inconclusive diagnosis of neuroborreliosis.

In children living in endemic areas, the presence of acute-onset PFP along with CSF pleocytosis characterised by over 90% lymphocytes has been found to have a high positive predictive value.[[3], [5]] Definitive diagnosis of neuroborreliosis, however, requires the detection of specific antibodies in CSF. Abbreviations CLIA Chemiluminescence immunoassay CMV Cytomegalovirus CNS Central nervous system CSF Cerebrospinal fluid CXCL13 C-X-C motiv chemokine ligand 13 EBV Epstein-Barr virus ED Emergency department ELISA Enzyme-linked immunosorbent assay Ig Immunoglobulin PCR Polymerase chain reaction PFP Peripheral facial nerve palsy WBC White blood count VZV Varicella-zoster virus INTRODUCTION In areas where pathogenic I Borrelia i spp. are endemic, over half of the children presenting with peripheral facial nerve palsy (PFP) are affected by neuroborreliosis.[[1]] In this setting, I Borrelia i spp. are the most frequent cause of paediatric PFP, surpassing idiopathic PFP (Bell's palsy).[[1]] Diagnosis of neuroborrelioses is based on cerebrospinal fluid (CSF) analysis. A second lumbar puncture will therefore have consequences on the diagnosis and treatment choice. [Extracted from the article]