We report the case of a 30-year-old man who developed severe
dysphagia owing to neuroborreliosis. He showed dysphagia,
diplopia, hiccups, and walking difficulty Neurological
examination revealed mild disturbance of consciousness, diplopia
on left lateral gaze, left-side-dominant blephaloptosis,
gaze-evoked horizontal nystagmus on left lateral gaze, mild
bilateral muscle weakness, palatoplegia, dysphagia, dysarthria,
and truncal ataxia An increased pharyngeal reflex caused
dysphagia in this patient. An EEG revealed intermittent high
amplitude slow wave activity. However, head MRI, blood count,
serum chemistry, and cerebrospinal fluid examination showed no
abnormality. Initially, brainstem encephalitis with unknown
etiology was diagnosed. The hiccups, diplopia, and ptosis were
improved by corticosteroid therapy, but other symptoms were
refractory to corticosteroid therapy and IVIg.