Acute myelitis accounts for 4 to 5 percent of all cases of neuro-borreliosis. In the literature, simultaneous spinal MRI and CSF investigations are recorded in only 8 cases. This paper reports 3 further cases of acute Lyme myelitis.

In a cohort of 45 patients with neuro-borreliosis diagnosed between January 1998 and 2005, 3 had acute myelitis. Clinical, biochemical and radiological data were reviewed.

The 3 patients with myelitis had motor, sensory and sphincter involvement. Extra-spinal features, such as fever and headache in one, a facial nerve palsy in the second and subarachnoid haemorrhage in the third, were also present. Pleiocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in the CSF in all 3. The intra-thecal anti-borrelia antibody index was positive or intermediate in all 3 patients.

Spinal cord MRI showed large, hyperintense lesions over 3 vertebral segments or more. The myelitis was central, posterior or transverse in the axial plane.

There was good clinical response to a 3-week course of antibiotics.

The 3 cases and those in the literature demonstrate the diversity of the clinical and radiological features of acute myelitis whether central, transverse or posterior. Thus CSF Lyme serology is indicated in all patients with acute myelitis, particularly in endemic areas.

25 references.