Exploring uncommon neurological presentations of Lyme’s disease; two case studies

<h3>Background</h3> Abducent nerve palsy, and acute radiculitis are rare manifestations of neuroborreliosis. We present two cases of Lyme’s disease, one with 6th and 7th cranial polyneuropathies, and the other with acute L2/L3 radiculitis with great response to antibiotics. <h3>Case Presentations</h3> <b>Case-1:</b> A previously healthy 21-year-old man presented acutely with painful horizontal diplopia, headaches, and vomiting, two weeks post a tick bite, without a rash, in the Scottish Highlands. Diagnosis revealed left abducent nerve palsy, treated with maximum deviation prisms. Later, he developed complete right LMN 7th nerve palsy. MRI with contrast showed asymmetrical enhancement of bilateral sixth nerves. CSF exhibited lymphocytic pleocytosis, and both CSF and serum were positive for Lyme serology. Treatment with doxycycline and intravenous ceftriaxone led to complete symptom resolution within weeks. <b>Case-2:</b> A 68-year-old woman observed a rash on her left thigh after a trip to Flamingo Land, followed by numbness and weakness in her left thigh and pain in her right groin. Testing revealed positive Lyme serology in both CSF and serum, with successful response to doxycycline and ceftriaxone. <h3>Conclusion</h3> These cases highlight the atypical presentations of neuroborreliosis, emphasizing the significance of timely recognizing them to initiate appropriate treatment promptly. This helps in averting potential long-term complications associated with untreated neuroborreliosis.