In acute disseminated Lyme disease, what neurologic manifestation is most common?

• A. Peripheral neuropathy
• B. Meningitis
• C. Cranial neuritis (Bell's palsy)
• D. Seizures

Answer: (C)

Cranial neuritis causing facial nerve palsy is the most common neurologic manifestation in acute disseminated Lyme disease. This stage often affects the nervous system through inflammation of cranial nerves, with the facial nerve (VII) being the usual target. Patients may present with sudden weakness of facial muscles, which can be unilateral or bilateral, and may occur in the context of other early disseminated Lyme symptoms. While meningitis and radiculopathy can occur, they are less frequent than facial palsy in this stage. Seizures are not typical features of acute neuroborreliosis. Prompt recognition and antibiotic treatment are important to address the infection and inflammation.