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At the annual meeting of the American Academy of Otolaryngology—Head and Neck Surgery, San Diego, Calif, September 1990, Terrance P. Murphy, MD, from the Brooke Army Medical Center, Fort Sam Houston, Tex, presented a paper on Lyme disease and how it can present with facial paralysis.
Lyme disease is the most common tick-borne illness in the United States, with over 3000 cases reported from 44 states in 1989. While patients typically present with cutaneous manifestations (erythema chronicum migrans), 15% to 25% of patients may exhibit neurologic symptoms as their initial complaint. Facial paralysis, including bilateral involvement, may be present in up to 50% of patients with neurologic symptoms and can be the sole symptom. Murphy stressed the importance of a careful history and high index of suspicion to rule out Lyme disease in patients with facial paralysis. Serologic testing for the disease should be obtained prior to treatment with steroids
SCOTT B. Pitfalls in the Evaluation of Lyme Disease. Arch Otolaryngol Head Neck Surg. 1991;117(1):19. doi:10.1001/archotol.1991.01870130025007