{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:13:38Z","timestamp":1788592418346,"version":"build-2803163510"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T00:00:00Z","timestamp":1727049600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,9,23]]},"abstract":"\n BACKGROUND<\/jats:title>\n Approximately 15% of Lyme disease cases involve the nervous system and are termed \u201cneuroborreliosis.\u201d A rare complication of neuroborreliosis is idiopathic intracranial hypertension with resulting neurological deterioration. There are very few reports of this in the literature, most of which consist of case reports and small case series. Neurosurgical intervention is exceedingly rare but may be needed in select cases.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 13-year-old male with Lyme disease and concurrent babesiosis with progressive headache, meningismus, emesis, and visual loss over several weeks. Serum and cerebrospinal fluid (CSF) testing confirmed a diagnosis of neuroborreliosis. Despite antimicrobial therapy and acetazolamide, visual loss worsened. An external ventricular drain (EVD) was urgently placed for CSF diversion. The use of CSF diversion, antimicrobial therapy, and acetazolamide led to significant improvement in the patient\u2019s symptoms with nearly complete resolution. The EVD could be weaned, and permanent CSF diversion was not needed.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights a rare but significant complication of neuroborreliosis. Intracranial hypertension with resulting neurological deterioration, while uncommon, can occur in patients with Lyme disease. Management is most often medical, consisting of intravenous antibiotics and acetazolamide to reduce CSF production. In rare cases, temporary CSF diversion is necessary and can provide significant benefits to select patients.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2451<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2451","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T02:44:04Z","timestamp":1727059444000},"source":"Crossref","is-referenced-by-count":2,"title":["Neuroborreliosis with intracranial hypertension and visual loss in a pediatric patient: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Andrew","family":"Ku","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared F","family":"Sweeney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L","family":"Terry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samhita","family":"Bheemireddy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Prabhala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A","family":"Adamo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Curr Opin Infect Dis","first-page":"259","article-title":"Lyme neuroborreliosis","volume":"32","author":"Halperin","year":"2019","unstructured":"Halperin JJ. 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Secondary intracranial hypertension in pediatric Lyme meningitis. J Child Neurol. 2023;38(10-12):611-616."},{"issue":"5","key":"bib5","series-title":"Eur J Pediatr","first-page":"1965","article-title":"Clinical manifestations of Lyme neuroborreliosis in children: a review","volume":"182","author":"Bruinsma","year":"2023","unstructured":"Bruinsma RAZomer TPSkogman BHvan Hensbroek MBHovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr. 2023;182(5):1965-1976."},{"issue":"4","key":"bib6","series-title":"J Trop Pediatr","first-page":"fmac060","article-title":"Lyme neuroborreliosis with intracranial hypertension and erythema multiforme: a rare presentation","volume":"68","author":"Chhajed","year":"2022","unstructured":"Chhajed MJain AGunasekaran PKDhaliwal NSaini L. Lyme neuroborreliosis with intracranial hypertension and erythema multiforme: a rare presentation. J Trop Pediatr. 2022;68(4):fmac060."},{"issue":"4","key":"bib7","series-title":"J Neuroophthalmol","first-page":"e498","article-title":"Papilledema secondary to neurologic Lyme borreliosis: a meta-case series","volume":"41","author":"Vaysbrot","year":"2021","unstructured":"Vaysbrot EEBannuru RRChristopher MCOsani MCHal\u00adperin JJ. Papilledema secondary to neurologic Lyme borreliosis: a meta-case series. J Neuroophthalmol. 2021;41(4):e498-e508."},{"issue":"2","key":"bib8","series-title":"Infect Dis Clin North Am","first-page":"281","article-title":"Lyme disease in children","volume":"29","author":"Sood","year":"2015","unstructured":"Sood SK. Lyme disease in children. 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J Magn Reson Imaging. 2022;56(3):645-654."},{"issue":"3","key":"bib26","series-title":"Infect Dis Clin North Am","first-page":"655","article-title":"Human babesiosis","volume":"36","author":"Waked","year":"2022","unstructured":"Waked RKrause PJ. Human babesiosis. Infect Dis Clin North Am. 2022;36(3):655-670."},{"key":"bib27","series-title":"Handb Clin Neurol","first-page":"199","article-title":"Neurological manifestations of human babesiosis","volume":"114","author":"Usmani-Brown","year":"2013","unstructured":"Usmani-Brown SHalperin JJKrause PJ. Neurological manifestations of human babesiosis. Handb Clin Neurol. 2013;114:199-203."},{"issue":"7","key":"bib28","series-title":"Cureus","first-page":"e26811","article-title":"Atypical presentation of babesiosis with neurological manifestations as well as hematological manifestations","volume":"14","author":"Venigalla","year":"2022","unstructured":"Venigalla TAdekayode CDoreswamy SAl-Sudani HSekhar S. Atypical presentation of babesiosis with neurological manifestations as well as hematological manifestations. Cureus. 2022;14(7):e26811."},{"key":"bib29","series-title":"Neurocrit Care","article-title":"Detection and management of elevated intracranial pressure in the treatment of acute community","author":"El-Hajj","unstructured":"El-Hajj VGPettersson IGharios M, et al. Detection and management of elevated intracranial pressure in the treatment of acute community-acquired bacterial meningitis: a systematic review. Neurocrit Care. Published online February 14, 2024. doi: 10.1007\/s12028-023-01937-5"},{"issue":"5","key":"bib30","series-title":"Infect Dis (Lond)","first-page":"356","article-title":"Use of intracranial pressure monitoring in bacterial meningitis: a 10-year follow up on outcome and intracranial pressure versus head CT scans","volume":"49","author":"Larsen","year":"2017","unstructured":"Larsen LPoulsen FRNielsen THNordstr\u00f6m CHSchulz MKAndersen \u00c5B. Use of intracranial pressure monitoring in bacterial meningitis: a 10-year follow up on outcome and intracranial pressure versus head CT scans. Infect Dis (Lond). 2017;49(5):356-364."},{"issue":"3","key":"bib31","series-title":"J Neurosurg","first-page":"831","article-title":"Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care","volume":"136","author":"Svedung Wettervik","year":"2022","unstructured":"Svedung Wettervik THowells TLjunghill Hedberg ALew\u00e9n AEnblad P. Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care. J Neurosurg. 2022;136(3):831-839."},{"issue":"5","key":"bib32","series-title":"Neurosurg Focus","first-page":"E7","article-title":"The role of ICP monitoring in meningitis","volume":"43","author":"Tariq","year":"2017","unstructured":"Tariq AAguilar-Salinas PHanel RANaval NChmayssani M. The role of ICP monitoring in meningitis. Neurosurg Focus. 2017;43(5):E7."},{"issue":"5","key":"bib33","series-title":"Clin Neurol Neurosurg","first-page":"399","article-title":"Raised intracranial pressure in acute viral encephalitis","volume":"111","author":"Kumar","year":"2009","unstructured":"Kumar GKalita JMisra UK. Raised intracranial pressure in acute viral encephalitis. Clin Neurol Neurosurg. 2009;111(5):399-406."},{"issue":"6","key":"bib34","series-title":"N Engl J Med","first-page":"557","article-title":"Acute viral encephalitis","volume":"379","author":"Tyler","year":"2018","unstructured":"Tyler KL. Acute viral encephalitis. N Engl J Med. 2018;379(6):557-566."},{"issue":"3","key":"bib1","series-title":"Curr Opin Infect Dis","first-page":"259","article-title":"Lyme neuroborreliosis","volume":"32","author":"Halperin","year":"2019","unstructured":"Halperin JJ. Lyme neuroborreliosis. 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J Trop Pediatr. 2022;68(4):fmac060."},{"issue":"4","key":"bib7","series-title":"J Neuroophthalmol","first-page":"e498","article-title":"Papilledema secondary to neurologic Lyme borreliosis: a meta-case series","volume":"41","author":"Vaysbrot","year":"2021","unstructured":"Vaysbrot EEBannuru RRChristopher MCOsani MCHal\u00adperin JJ. Papilledema secondary to neurologic Lyme borreliosis: a meta-case series. J Neuroophthalmol. 2021;41(4):e498-e508."},{"issue":"2","key":"bib8","series-title":"Infect Dis Clin North Am","first-page":"281","article-title":"Lyme disease in children","volume":"29","author":"Sood","year":"2015","unstructured":"Sood SK. Lyme disease in children. 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