A Unified Cause of Cranial Polyneuropathy | Facial Nerve | JN Learning | AMA Ed Hub [Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.206.177.17. Please contact the publisher to request reinstatement.
[Skip to Content Landing]

A Unified Cause of Cranial Polyneuropathy

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A healthy man in his mid 30s residing in the northeastern United States was seen by his primary care physician in mid-June with a 2-week history of flulike symptoms. He was empirically started on doxycycline because he reported frequenting wooded areas.

One week later, he developed a complete right facial nerve paralysis. He was started on a course of prednisone, with subsequent full recovery of facial nerve function. About 2 weeks later, he reported new-onset right-sided hearing loss, tinnitus, and intermittent otalgia. He was evaluated in the otology clinic approximately 3 weeks after the onset of these otologic symptoms. He had no prior otologic history and no history of noise exposure. His otologic and head and neck examination findings were unremarkable.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

C. Neuroborreliosis cranial polyneuritis

Lyme disease, or Lyme borreliosis, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States, seen particularly in the coastal Northeast, upper Midwest, and West.1,2 It is a multisystem disease transmitted to humans by infected ticks of the Ixodes species. Otolaryngologic manifestations, including neck pain and stiffness, sore throat, dizziness, lymphadenopathy, otalgia, tinnitus, cranial nerve neuritis, and hearing loss, affect up to 75% of patients.3 In this patient, the diagnosis of Lyme disease was confirmed in a standard fashion by a positive IgM immunoblot, which showed reactivity to 23-, 39-, and 41-kDa proteins. Lyme disease typically manifests in 3 clinical stages of early localized disease, early disseminated disease, and late disease.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Alexander G. Bien, MD, Albany ENT & Allergy Services, PC, 400 Patroon Creek Blvd, Ste 205, Albany, NY 12206 (bienag@gmail.com).

Published Online: December 20, 2018. doi:10.1001/jamaoto.2018.3626

Conflict of Interest Disclosures: None reported.

References
1.
Coumou  J, van der Poll  T, Speelman  P, Hovius  JW.  Tired of Lyme borreliosis: Lyme borreliosis in the Netherlands.  Neth J Med. 2011;69(3):101-111.PubMedGoogle Scholar
2.
Agarwal  R, Sze  G.  Neuro-Lyme disease: MR imaging findings.  Radiology. 2009;253(1):167-173.PubMedGoogle ScholarCrossref
3.
Lorenzi  MC, Bittar  RS, Pedalini  ME, Zerati  F, Yoshinari  NH, Bento  RF.  Sudden deafness and Lyme disease.  Laryngoscope. 2003;113(2):312-315.PubMedGoogle ScholarCrossref
4.
Girschick  HJ, Morbach  H, Tappe  D.  Treatment of Lyme borreliosis.  Arthritis Res Ther. 2009;11(6):258.PubMedGoogle ScholarCrossref
5.
Pachner  AR, Steiner  I.  Lyme neuroborreliosis: infection, immunity, and inflammation.  Lancet Neurol. 2007;6(6):544-552.PubMedGoogle ScholarCrossref
6.
Peeters  N, van der Kolk  BY, Thijsen  SF, Colnot  DR.  Lyme disease associated with sudden sensorineural hearing loss: case report and literature review.  Otol Neurotol. 2013;34(5):832-837.PubMedGoogle ScholarCrossref
7.
Ewers  EC, Dennison  DH, Stagliano  DR.  A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging.  Pediatr Neurol. 2015;52(1):107-109.PubMedGoogle ScholarCrossref
8.
Demaerel  P, Wilms  G, Casteels  K, Casaer  P, Silberstein  J, Baert  AL.  Childhood neuroborreliosis: clinicoradiological correlation.  Neuroradiology. 1995;37(7):578-581.PubMedGoogle ScholarCrossref
9.
Köchling  J, Freitag  HJ, Bollinger  T, Herz  A, Sperner  J.  Lyme disease with lymphocytic meningitis, trigeminal palsy and silent thalamic lesion.  Eur J Paediatr Neurol. 2008;12(6):501-504.PubMedGoogle ScholarCrossref
10.
Quinn  SJ, Boucher  BJ, Booth  JB.  Reversible sensorineural hearing loss in Lyme disease.  J Laryngol Otol. 1997;111(6):562-564.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close