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Bell palsy in Lyme disease–endemic regions of Canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease

Published online by Cambridge University Press:  11 May 2015

Karen Ho ,
Michel Melanson  and
Jamsheed A. Desai
Karen Ho
Affiliation:
Department of Medicine, Division of Neurology, Queen's University, Kingston, ON
Michel Melanson
Affiliation:
Department of Medicine, Division of Neurology, Queen's University, Kingston, ON
Jamsheed A. Desai*
Affiliation:
Department of Medicine, Division of Neurology, Queen's University, Kingston, ON
*
Queen's University, Department of Medicine, Division of Neurology, Kingston General Hospital, Connell 7-76 Stuart Street, Kingston, ON K7L 2V7; 3jd14@queensu.ca.

Abstract

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Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease–endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease–endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease–endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.

Keywords

Bell palsyCanadaendemic regionsfacial nerveLyme disease
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 5 , September 2012 , pp. 321 - 324
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

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