Excerpt:

Lyme disease is most prevalent in the northeast and upper Midwest
regions of the United States. While early symptoms may be mild
(eg, rash, flu-like symptoms, joint pain), late or persistent
infection can cause chronic neurologic impairments. Because of
this range of symptoms, physicians can have difficulty diagnosing
Lyme disease, especially in the absence of erythema chronicum
migrans. We report a case of a woman who initially presented with
severe vertigo and vomiting and later with fever, headache, and
facial droop. After more than 3 weeks of misdiagnosis, the
patient tested positive for Lyme disease and was diagnosed as
having neuroborreliosis presenting as Bell palsy and meningitis.
The authors review the history, diagnosis, and management of Lyme
disease.