Bilateral facial palsy following a tick bite

Abstract

Simultaneous bilateral facial palsy is a diagnostic challenge that can sometimes lead to the discovery of a systemic disease. Therefore, in most cases, this pathological entity requires in-patient investigations and treatment. Herein, we present a case of a 40-year-old woman who developed a severe bilateral facial palsy 4 weeks after a tick bite. The extensive clinical investigations led to the discovery of a neuroborreliosis. The patient was initially treated with intravenous ceftriaxone. After the exclusion of a central involvement, the treatment was continued by oral doxycicline with almost complete remission of symptoms. In this report, we stress the differential diagnosis of bilateral facial palsy and discuss neuroimaging findings and treatment options in neuroborreliosis.