Argyll Robertson pupils in lymphocytic meningoradiculitis (Bannwarth's syndrome)

Sir: Lymphocytic meningoradiculitis or Bannwarth's syndrome is clinically characterised by severe radicular pains with sensory and motor impairment and cranial nerve palsies, especially unilateral or bilateral facial weakness.'`4 The syndrome is probably a European variety of Lyme disease, 5 which is caused by a spirochete, Borrelia burgdorferi,6 and transmitted by the bite of a tick. In Bannwarth's syndrome antibodies to the same7 or to closely related8 spirochetes are found. CSF findings such as elevated protein and pleocytosis' - 3 are consistent with aseptic meningitis. The disease is often self-limiting, but the course of the disease and the duration of pain may be shortened by high doses of penicillin given intravenously. 9 In some cases it may be difficult to distinguish Bannwarth's syndrome from neurosyphilis. We present such a case. ..