Isolated trochlear palsy in Lyme disease may persist

We present an 8-year-old boy with neuroborreliosis diagnosed by single symptom of trochlear palsy: Since 4 weeks, he felt visual impairment on his right eye and sliding of the right bulbus to right side and up. In summer, 2 months before, ticks were seen on his skin. With diagnosis of trochlear palsy, he was sent to our hospital.

We saw typical clinical trochlear palsy on his right eye, no other neurological or general symptoms. Cranial MRI was normal, in cerebrospinal fluid slightly increased protein (515 mg/L) and cells (27/3 lymphocytes), all IgG and IgM antibodies specific for Lyme disease (p100-IgG, p18-IgG,OspC-IgM) positive, as well quotient of IgM/albumin. He was treated with ceftriaxone IV for 14 days (50 mg/kg/d). After 3 months, the trochlear palsy is not completely resolved.

We discuss a trochlear palsy as monosymptomatic cause of Lyme disease. Only few cases are described in children and adults, always with complete recovering. Our case remains outstanding and is similar to various cases in follow up of Bell palsy in children.