Stupica D, Bajrović FF, Blagus R, et al. - Researchers conducted this retrospective cohort study to evaluate clinical and microbiologic features, management, and long-term outcome of early Lyme neuroborreliosis (LNB) according to diagnostic certainty (definite vs possible) in a highly endemic European region. Between January 2008 and December 2017, patients ≥ 18 years old hospitalized at the University Medical Center in Ljubljana, Slovenia, and discharged with a diagnosis of LNB were evaluated for the study. From 2008 to 2017, 311 adult patients were enrolled, with 139 (44.7%) having definite LNB and 172 (55.3%) having possible LNB. Cranial neuropathy with or without meningitis was the most common LNB manifestation. Patients with definite LNB had a higher rate of Bannwarth syndrome, severe disease, a longer pre-treatment duration, higher cerebrospinal fluid pleocytosis, and a higher rate of Borrelia seropositivity than those with possible LNB. Early LNB, which most commonly manifested as cranial neuropathy, was definitively diagnosed in less than half of the cases. To confirm borrelial etiology, a more accurate diagnostic approach is required. Regardless of diagnostic certainty, ceftriaxone was not superior to doxycycline in the treatment of early LNB.