Can Lyme Disease Cause Unilateral Numbness?
Yes, Lyme disease can cause unilateral numbness through peripheral nervous system involvement, particularly via radiculoneuropathy, mononeuropathy multiplex, or cranial neuropathies. 1
Mechanisms of Neurologic Involvement
Lyme neuroborreliosis affects the peripheral nervous system in several ways that can produce unilateral numbness:
Radiculoneuropathy is a recognized acute manifestation of Lyme neuroborreliosis, presenting as painful radiculitis that can affect specific nerve root distributions unilaterally 1, 2
Mononeuropathy multiplex (including confluent mononeuropathy multiplex) represents multifocal involvement of anatomically unrelated nerves and is an established presentation requiring testing for Lyme disease when epidemiologically plausible 1
Cranial neuropathies, particularly involving cranial nerves VII, VIII, and less commonly III, V, and VI, can produce unilateral sensory symptoms in their respective distributions 1
Clinical Context and Timing
The presentation depends on disease stage:
Early disseminated disease (days to weeks after infection) commonly manifests with cranial neuropathies and radiculoneuritis 1, 2
Late peripheral neuropathy typically presents as a mild, diffuse "stocking-glove" process with intermittent limb paresthesias, though this is usually bilateral rather than strictly unilateral 1
Unilateral presentations are more characteristic of focal nerve involvement (radiculoneuropathy or mononeuropathy) rather than the diffuse polyneuropathy pattern 1
Diagnostic Approach
When evaluating unilateral numbness for possible Lyme disease:
Testing is recommended for patients presenting with acute painful radiculoneuritis, mononeuropathy multiplex, or cranial neuropathies with epidemiologically plausible tick exposure 1
Serum antibody testing (two-tier ELISA followed by Western blot) is the preferred diagnostic strategy over PCR or culture 1
For peripheral nervous system manifestations, CSF findings may be normal without evidence of intrathecal antibody production, as the pathophysiologic process often occurs outside the subarachnoid space 1
Important Caveats
Several critical points warrant emphasis:
Isolated sensory symptoms without objective findings are not typical of Lyme neuroborreliosis and should prompt consideration of alternative diagnoses 1
Testing is NOT recommended for nonspecific neurologic symptoms without other clinical or epidemiologic support for Lyme disease 1
The most common objective neurologic manifestations are meningitis, cranial neuropathies (especially facial nerve palsy), and radiculoneuropathy—not isolated sensory complaints 2, 3, 4
Post-treatment subjective symptoms (including paresthesias) can occur but typically represent slow resolution of inflammation rather than active infection 1
Treatment Implications
If Lyme-associated peripheral nerve involvement is confirmed:
IV ceftriaxone, cefotaxime, penicillin G, or oral doxycycline are recommended for 14-21 days for peripheral nervous system manifestations 1
In the United States, treatment with IV ceftriaxone usually results in improvement of peripheral neuropathy 1
Some patients may have residual neurologic impairment attributable to irreversible neurologic damage rather than persistent infection 1