Abstract Details

Title Bannwarth Syndrome Mimicking Neurolymphomatosis

Topic General Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 2-004

Background Bannwarth syndrome causes painful radiculopathy, cranial neuritis and lymphocytic pleocytosis as a result of Lyme disease. The diagnosis is challenging due to variable symptoms on presentation, and often equivocal tick exposure and lab findings.

Objective

To describe a case of Bannwarth syndrome mimicking neurolymphomatosis

Design/Methods

Case study

Results A 54 year old man with hyperlipidemia and lumbar discopathy presented with upper back pain and left upper extremity weakness and numbness. On examination, no upper motor neuron signs in the upper or lower extremities were appreciated. Contrasted MRI of the neuroaxis revealed extensive and symmetric enhancement of the cervical and thoracic nerve roots, cauda equina and bilateral trigeminal nerves. Cerebrospinal fluid testing was notable for 445/uL red blood cells, 221/uL nucleated cells, 333/uL protein, 51/uL glucose. CSF cytology showed "atypical lymphocytes suspicious for lymphoma”. Lyme IgM and IgG Western Blots resulted positive. The patient divulged a history of occasional tick bites and recent skin rash related to a bug bite without bull’s eye appearance or associated joint symptoms. During his hospitalization, he developed a right facial droop which progressed to facial diplegia. Intravenous ceftriaxone was started due to concern for Bannwarth syndrome. Electrodiagnostic studies disclosed motor radiculopathy affecting left C5-T1 roots and a subacute left facial axonal neuropathy. Cytology from repeat lumbar puncture again demonstrated atypical cells, but no definite evidence of lymphoma. He was discharged in stable condition with plans to complete a 28-day course of intravenous ceftriaxone. On his follow-up visit 14 days post-discharge, he continued to demonstrate improving facial muscle strength and sensation in his left upper extremity.

Conclusions This case highlights Bannwarth syndrome as an etiology for acute radiculoneuritis and cranial neuritis, and the importance of careful history taking and need for repeat testing in cases with competing differentials, including the mimicker of neurolymphomatosis.

Authors/Disclosures
Sanem P. Uysal, MD PRESENTER	Dr. Uysal has nothing to disclose.
John A. Morren, MD, FAAN (Cleveland Clinic)	Dr. Morren has received publishing royalties from a publication relating to health care.