{
  "abstract": "Lyme disease is a tick-borne multi-system zoonosis, following infection with Borrelia species, which cannot be locally acquired in Australia. Cases in Australia are acquired from travellers returning from endemic areas. Neuroborreliosis encompasses the neurological manifestations of Lyme disease and requires certain clinical and biochemical criteria.We report the case of a 47-year-old woman, originally from the Czech Republic, who presents with subacute progressive right-sided ‘electric’ occipital headache, to the point of interrupting sleep. There was associated nausea but no other features of meningism. There were no focal neurological signs. She had returned from visiting Prague one month prior. Background history was significant for Lyme disease manifesting as skin rash in adolescence. Magnetic resonance imaging demonstrated longitudinally extensive signal alteration within the upper cervical spinal cord. Cerebrospinal fluid (CSF) analysis demonstrated lymphocytic pleocytosis with serum and CSF serology suggestive of neuroborreliosis, although interpretation was complicated by patient’s prior exposure. Given high suspicion for neuroborreliosis, treatment with intravenous ceftriaxone was commenced with dramatic improvement in headache within days.This case highlights an unusual presentation of neuroborreliosis, with discordance between clinical and radiological findings. On literature review, neuroborreliosis usually manifests within 1 to 12 weeks of tick bite with painful meningoradiculitis, cranial neuritis or lymphocytic meningitis. Myelitis is a rare manifestation of early neuroborreliosis. There are few case reports detailing patients with myelitis and minimal clinical signs. It is important to consider Lyme disease as a possible diagnosis in patients presenting with neurological symptoms, who have recently returned from endemic areas.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Fiona Stanley Hospital, Murdoch, WA, Australia"
      ],
      "name": "Yasmin Soliman"
    },
    {
      "affiliations": [
        "Neurology, Fiona Stanley Hospital, Murdoch, WA, Australia",
        "Neurology, St John of God Murdoch Hospital, Murdoch, WA, Australia"
      ],
      "name": "Jason Burton"
    }
  ],
  "title": "3671 Neuroborreliosis in Australia: a case of severe headache in a returned traveller",
  "uid": "e6dea362-bba3-5c68-aa50-f770ca47aba2"
}