Acute vestibular dizziness in neuroborreliosis

Neuroborreliosis is a neurological complication of Lyme disease and is characterized by predominant involvement of the meninges, cranial nerves, nerve roots, and peripheral nerves. Acute vestibular dizziness (AVD) in neuroborreliosis occurs rarely and poses significant diagnostic difficulties. We present a clinical observation of a 52-year-old female patient with AVD accompanied by nausea, repeated vomiting, and severe gait instability. Examination revealed horizontal spontaneous nystagmus intensifying on gaze to the right, a positive Halmagyi test on the left, and severe gait ataxia. Brain MRI revealed no pathological changes. Before examination at the Clinic of Nervous Diseases (CND) of Sechenov University, the condition was regarded as vertebrobasilar insufficiency with vestibulo-atactic syndrome. Neurometabolic therapy produced no effect. Examination at the CND established vestibular neuronitis in combination with headache, meningeal symptoms, proximal weakness in the lower limbs, absent knee reflexes and decreased Achilles reflexes, as well as sensory disturbances in the lower limbs, reflecting manifestations of neuroborreliosis. Several months before the development of AVD, the patient developed erythematous skin lesions on the lower limbs, followed by severe pain syndrome in the legs. Cerebrospinal fluid (CSF) examination confirmed the diagnosis of neuroborreliosis with involvement of the meninges, nerve roots, and cranial nerves in the form of vestibular neuronitis and facial nerve neuropathy. For the treatment of AVD, a fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg (Arlevert) was prescribed, and within 60 minutes after taking the drug, marked reduction in dizziness intensity and improvement in general condition were noted. After a 21-day course of antibacterial therapy, marked positive dynamics were observed with complete regression of vestibular and other neurological manifestations, as well as inflammatory changes in the CSF.