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Cerebrospinal fluid white blood cell count,protein level,or both were abnormal in 27(68%)of the children.Thirty-six(90%)of the 40 children had CSF abnormality consistent with central nervous system infection or immune involvement by B burgdorferi.Of the 22 children with CSF pleocytosis,only 7(32%)had headache and none had meningeal signs.Most children with Lyme disease-associated facial nerve palsy have CSF abnormalities.Our studies indicate that,in endemic areas,facial nerve palsy in children may be a marker of Lyme disease and occult meningitis.When Lyme disease is suspected,CSF should be examined;in some cases,it may be helpful to expand beyond routine CSF studies to look at a battery of B burgdorferi-specific assays. |
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