Child neurologists at Baskent University Faculty of Medicine, Turkey, report the case of a 5-year-old girl from the Mediterranean region of Anatolia with a 4-day history of progressive ataxia. History of fever, rash or tick bite was absent. Neurologic examination revealed cerebellar signs without signs of meningitis or cranial nerve involvement. CT and MRI were normal and CSF showed a mild pleocytosis and normal protein and glucose. Serological evaluation for Borrelia burgdorferi was positive and IV cefotaxime was begun. Serum markers for other infectious diseases sometimes complicated by cerebellar ataxia were negative; these included herpes simplex, cytomegalovirus, varicella zoster, mumps, rubella, rubeola, Epstein-Barr virus, and mycoplasma. At discharge on day 28, the neurologic exam was normal, and serum for B burgdorferi IgM and IgG antibodies was positive. 
COMMENT. Neuroborreliosis presents with both central and peripheral nervous system manifestations, including aseptic meningitis, meningoencephalitis, Bell’s palsy, radiculoneuritis, and myelitis. Four previously published reports of cerebellar ataxia with Lyme disease are reviewed.