The neurologic manifestations and syndromes associated with Lyme disease are reported in 96 patients, ages 3 to 19 years, living on Long Island and referred to University Hospital, Stony Brook, New York. All were seropositive for anti-B burgdorferi antibodies. One-third had no prior history of extraneural manifestations of Lyme disease (erythema migrans, arthritis, flulike symptoms, and arthralgias/myalgias), and 90% had no memory of a tick bite. The most frequent neurologic symptom was headache (in 71%), and the most common sign was facial palsy (14%). Sleep disturbance was reported in 7%, papilledema was present in 6%, diplopia in 2%, and 1 had a Guillain-Barre-like syndrome with a CSF protein of 231 mg/dL. Elevations in CSF protein (32-58 mg/dL) were found in 25 of 53 patients examined, and a mild lymphocytic pleocytosis in 15. Neurologic syndromes included encephalopathy, lymphocytic meningitis, cranial neuropathy, and pseudotumor cerebri. 
COMMENT. The clinical course of Lyme disease in most children in this study was milder and shorter than that reported for adults, and meningoradiculitis (Bannwarth’s syndrome) and peripheral neuropathy syndromes were rare. A pseudotumor cerebri syndrome appears to be unique to childhood Lyme disease. A first report of stroke caused by Lyme disease in North America involved a woman of 56 years.