Neuroborreliosis in South Wales

On 23rd of March 1991 a 43 year old aircraft inspector from Chepstow was referred with six weeks increasing frontal headache, keeping him awake at night and relieved by standing UPThere was no nausea,vomiting or photophobia. Five days before admission he was watching television and suddenly developed double vision more marked to the left. There was no nausea vomiting, giddiness, fevers, sweats or systemic upset. He was perfectly well prior to this. He did suffer from a recurrent rash on his thighs, trunk and limbs which had been diagnosed as granuloma annulare by a dermatologist. There was no arthropathy. He had taken up hill walking recently and visited the Forest of Dean and areas around South Wales. On examination the only positive findings were bilateral lateral recti palsy more marked on the left.