{
  "abstract": "A 60-year-old woman presented with a 38-month history of progressive tremor and gait impairment. Examination was consistent with a myeloradiculopathy, cerebrospinal fluid (CSF) analysis was inflammatory and imaging showed meningeal and white matter disease. Revisiting the history identified long periods spent gardening in the months before symptom onset with significant tick exposure. Lyme testing was strikingly positive in serum and CSF: a diagnosis of late Lyme neuroborreliosis was confirmed. There was clinical and radiological response to appropriate antimicrobial treatment with ongoing improvement at follow-up. This case highlights the importance of thorough history taking, a stepwise approach to investigating a complex neurological syndrome and the invaluable input of multiple specialties required to manage such cases.",
  "authors": [
    {
      "affiliations": [
        "Neurology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Milo Patrick Delaney"
    },
    {
      "affiliations": [
        "Neurology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Andrea P Ruiz"
    },
    {
      "affiliations": [
        "Neurology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Ahmed Morgan"
    },
    {
      "affiliations": [
        "Neurology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Shayan Ashjaei"
    },
    {
      "affiliations": [
        "King’s College London, London, UK"
      ],
      "name": "Nicholas Williamson"
    },
    {
      "affiliations": [
        "Neuroradiology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Jay Patel"
    },
    {
      "affiliations": [
        "Infection Sciences, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Temi Lampejo"
    },
    {
      "affiliations": [
        "Rare and Imported Pathogens Laboratory, Porton Down, UKHSA Porton, Salisbury, UK"
      ],
      "name": "Christina Petridou"
    },
    {
      "affiliations": [
        "Neurology, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Laura Mantoan Ritter"
    }
  ],
  "title": "Late Lyme neuroborreliosis presenting with tremor and gait impairment",
  "uid": "93273fb7-8b31-5c68-b76b-bd523102b486"
}