A PATIENT who may or may not have had exposure to Borrelia burgdorferi–infected ticks presents with chronic malaise, a perception of impaired cognition and memory, and depression. These symptoms may or may not have been preceded by classic Lyme disease manifestations. Antibiotics may or may not have been given. Is this disorder chronic central nervous system (CNS) Lyme disease? This diagnosis, often applied in such circumstances, explicitly or implicitly poses 4 questions: Does the patient have Lyme disease? Does the patient have an infection of the CNS (neuroborreliosis)? If the illness is due to Lyme disease, why is there such interindividual variability in disease manifestations? Finally, and most important, if not Lyme disease, what is this disease that is so different from "textbook" Lyme disease?
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