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This case highlights the importance of thorough history taking, a stepwise approach to investigating a complex neurological syndrome and the invaluable input of multiple specialties required to manage such cases.<\/jats:p>","DOI":"10.1136\/pn-2025-005006","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T18:20:40Z","timestamp":1768414840000},"page":"pn-2025-005006","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Late Lyme neuroborreliosis presenting with tremor and gait impairment"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-4085","authenticated-orcid":false,"given":"Milo Patrick","family":"Delaney","sequence":"first","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"P Ruiz","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Morgan","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shayan","family":"Ashjaei","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Williamson","sequence":"additional","affiliation":[{"name":"King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Patel","sequence":"additional","affiliation":[{"name":"Neuroradiology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temi","family":"Lampejo","sequence":"additional","affiliation":[{"name":"Infection Sciences, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Petridou","sequence":"additional","affiliation":[{"name":"Rare and Imported Pathogens Laboratory, Porton Down, UKHSA Porton, Salisbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Mantoan Ritter","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"2026011410202552000_pn-2025-005006v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-52902-2.00032-1"},{"key":"2026011410202552000_pn-2025-005006v1.2","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2018-001998"},{"key":"2026011410202552000_pn-2025-005006v1.3","doi-asserted-by":"crossref","first-page":"102523","DOI":"10.1016\/j.ttbdis.2025.102523","article-title":"An update on Borrelia burgdorferi s.l. prevalence and hazard in ticks at recreational areas in England and Wales between 2021 and 2023","volume":"16","author":"Gandy","year":"2025","journal-title":"Ticks Tick Borne Dis"},{"key":"2026011410202552000_pn-2025-005006v1.4","doi-asserted-by":"crossref","first-page":"102509","DOI":"10.1016\/j.ttbdis.2025.102509","article-title":"Using meta-analysis to estimate the incidence of Lyme borreliosis clinical manifestations in Denmark, Ireland and Sweden based on publicly-available Lyme neuroborreliosis data","volume":"16","author":"Brestrich","year":"2025","journal-title":"Ticks Tick Borne Dis"},{"key":"2026011410202552000_pn-2025-005006v1.5","doi-asserted-by":"crossref","first-page":"100017","DOI":"10.1016\/j.clinpr.2020.100017","article-title":"A retrospective observational study of Lyme neuroborreliosis in the southwest of England","volume":"6","author":"Petridou","year":"2020","journal-title":"Clinical Infection in Practice"},{"key":"2026011410202552000_pn-2025-005006v1.6","doi-asserted-by":"crossref","first-page":"102439","DOI":"10.1016\/j.ttbdis.2025.102439","article-title":"Seroprevalence of Borrelia burgdorferi sensu lato antibodies in English adult blood donors: A nationwide cross-sectional study, 2021-2022","volume":"16","author":"Hart","year":"2025","journal-title":"Ticks Tick Borne Dis"},{"key":"2026011410202552000_pn-2025-005006v1.7","doi-asserted-by":"crossref","first-page":"100414","DOI":"10.1016\/j.ijregi.2024.100414","article-title":"A serosurvey examining exposure to Borrelia burgdorferi sensu lato and tick-borne encephalitis virus in Danish blood donors, August 2022","volume":"12","author":"Hansen","year":"2024","journal-title":"IJID Regions"},{"key":"2026011410202552000_pn-2025-005006v1.8","unstructured":"Common animal-associated infections (england) annual report: 2024. 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