We studied retrospectively the medical records of all patients diagnosed with neuroborreliosis (NB) by cerebrospinal fluid (CSF) analysis in Jönköping County, Sweden, during 2000-2005 (n=150). The number of NB cases increased from 5 to 10/100,000 inhabitants/year. In 17% of the patients, Borrelia-antibodies were found in CSF but not in serum at the time of diagnosis. Facial palsy, headache and fever were frequent manifestations in children, whereas unspecific muscle and joint pain were the most commonly reported symptoms in older patients. Symptoms persisting more than six months post-treatment occurred in 13%, and these patients were significantly older, had longer duration of symptoms prior to treatment, higher levels of Borrelia-specific IgG in CSF and more often radiculitis. The total cost for NB-related health care was estimated to 500,000 EUR for the entire study group (3,300 EUR/patient), and the cost for social benefits to 134,000 EUR (2,000 EUR/patient). CSF analysis is necessary for NB diagnosis since some patients develop antibodies in serum later than in CSF. Early diagnosis of borreliosis would result in reduced human suffering and economic gain.