The statement that LNB causes nonspecific white matter lesions is based on weak scientific evidence. In very few case reports was the positron emission tomography (PET) used. A 22-year-old woman was admitted to the emergency room with sudden right peripheral facial palsy. Magnetic resonance imaging showing (A) signal abnormality, suggesting inflammatory lesions in a vertebrobasilar distribution; medulla, pons, and cerebellum. Lyme serology was positive both in blood and CSF and intrathecal Borrelia burgdorferi antibody production was confirmed. Numerous literature references concerning LNB do not discuss proton magnetic resonance spectroscopy (1H-MRS) examinations of the brain in this disease. Wormser GP, Dattwyler RJ, Shapiro ED, et al. 6. (PMID: 30187265), [5] Wormser GP, Dattwyler RJ, Shapiro ED, et al. Enhancement after gadolinium chelate administration on T1-weighted images is the common finding (Figure 2CF). Guillain Neuro-lyme disease: MR imaging findings official website and that any information you provide is encrypted Lyme serology was positive in both blood and CSF, and intrathecal Borrelia burgdorferi antibody production was confirmed. These phenomena are observed in approximately 0.3% of patients with LB [18, 19]. Often, multiple parts of the CNS are involved at the same time (e.g. Lyme disease. This work is licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. At the time the article was last revised Rohit Sharma had no recorded disclosures. The European Federation of Neurological Societies (EFNS), the American Academy of Neurology (AAN), and the Infectious Diseases Society of America (IDSA) have all recommended specific criteria for the diagnosis of LNB. A follow-up MRI scan showed the brainstem lesion to be smaller and without enhancement [16]. No abnormalities were revealed on the CT of the brain. No abnormalities were revealed on the CT of the brain. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. 8600 Rockville Pike An official website of the United States government. In contrast to the previous 1H-MRS study, the long TE (TE=135 ms) was selected to evaluate the changes in the NAA/Cr ratio more precisely. Plotkin et al [24] reported a case of a 58-year-old woman who experienced progressive dysesthesia, abasia, and ataxia together with nausea and vomiting. {"url":"/signup-modal-props.json?lang=us"}, Di Muzio B, Bell D, Sharma R, et al. Garkowski A, Kubas B, Haduski M, et al. No statistically significant abnormality was observed regarding mean N-acetylaspartate (NAA)/Cr and lactate (Lac)/Cr ratios, although in 4 patients a decreased NAA/Cr ratio was found. (A) Fluid-attenuated inversion recovery (FLAIR) image, and (B) T2-weighted image shows numerous, mainly ovoid, hyperintense, periventricular white matter lesions perpendicular to the body of the lateral ventricle, initially assumed to be demyelination. Imaging in Lyme neuroborreliosis 1 Infections can involve any part of the CNS, including the meninges, ventricular system, brain parenchyma, cerebellum, brainstem, and spinal cord. The statement that LNB causes nonspecific white matter lesions is based on weak scientific evidence. 2006;43 (9): 1089-134. Lumbar puncture showed lymphocytic pleocytosis in cerebrospinal fluid (CSF). 2010;17(1):8-16, e1-4. In a study by Agarwal and Sze [13], the authors compared MRI findings of 66 patients suffering from LNB with 50 healthy control subjects. Magnetic resonance imaging of a 40-year-old woman with headache, neck, bilateral shoulder and arm pain. In this case, LNB was confirmed by stereotactic biopsy and serological studies. Several subtypes have been described including: acute inflammatory demyelinating polyradiculoneuropathy (AIDP) most common form (60-90%) Lyme serology was positive both in blood and CSF and intrathecal Borrelia burgdorferi antibody production was confirmed. Clinical presentation The classical presentation of Guillain-Barr syndrome includes symmetrical ascending muscle paresis/paralysis, areflexia/hyporeflexia, and variable sensory or autonomic involvement. {"url":"/signup-modal-props.json?lang=us"}, Di Muzio B, Sharma R, Stewart M, et al. Potential conflicts of interest. Neurologic Lyme Disease 2) was also appreciated. The MRI showed hemorrhagic bitemporal lesions with a peripheral contrast enhancement (Figure 7) [17]. If no abnormalities are revealed, it might mean delayed symptoms onset or involvement of small blood vessels not visible on conventional arteriographic images. Lyme serology was positive in both blood and CSF, and intrathecal Borrelia burgdorferi antibody production was confirmed. Dis. However, this lesion could also be incidental, and thus not related to LNB. Infect. Eur J Neurol. Severe Lyme neuroborreliosis with bilateral hemorrhagic temporal encephalitis. Lyme disease, also known as borreliosis, is a condition caused by the bacteria Borrelia burgdorferi,with infection being via the ixodid tick. (A) A 22-year-old woman with left facial nerve palsy and meningitis in the course of Lyme neuroborreliosis. Axial magnetic resonance imaging (MRI) of a 19-year-old man with a right-sided facial nerve palsy and confirmed diagnosis of early Lyme neuroborreliosis (LNB). This modality offers higher anatomical resolution, better soft tissue contrast, and multiplanar imaging acquisition; it also utilizes nonionizing electromagnetic radiation. Topakian R, Artemian H, Metschitzer B, et al. The same may be stated regarding the posterior region of the lobes (P=.001 and P=.031). The https:// ensures that you are connecting to the The Author(s) 2020. (C) Corresponding hypermetabolic areas on fluorodeoxyglucose-positron emission tomography imaging suggesting inflammation/vasculitis. Neurobrucellosis Unfortunately, most CT and MRI findings of the brain and spine in patients with Lyme disease are often within normal limits, even among patients with known neurological manifestations, writes Alves Simo. (C) Axial precontrast T1-weighted image, and (D) axial postcontrast T1-weighted image showed bilateral facial nerve enhancement (arrows). Federal government websites often end in .gov or .mil. Insights Imaging. In conclusion, Lyme borreliosis should be included in the differential diagnosis if compatible MRI findings (white matter lesions, meningeal and nerve enhancement) are seen in an appropriate clinical context [2,4]. No Lip and Lac peak was also observed in patients with LNB in this study. Z., wrote sections of the manuscript. 2020;267:852854. The focal point is on the manifestations of involvement visible on brain and spine imaging. 3). In rare cases, LNB may manifest as hemorrhagic encephalitis. Three disease stages have been proposed manifesting after the tick bite 2: stage 1: flu-like illness and enlarging skin lesion (erythema migrans) (2-30 days) stage 2: cardiac and neurological symptoms (1-4 months) stage 3: arthritis and neurological symptoms (many years) Lyme disease has nonspecific symptoms with multisystemic involvement 1,2 : . in meningoencephalitis). The cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis. Technique Reveals Brain Inflammation Associated In a report of a pediatric case of a 15-year-old boy with confirmed LNB, an MRI showed acute ischemic lesions in the medulla, pons, and cerebellum corresponding with hypermetabolic areas on FDG-PET, suggesting inflammation/vasculitis (Figure 11) [25]. In a recent German study, 8 patients were classified as having encephalitis (12%) based on clinical features [7]. However, this is based on anecdotal observations and not supported by systematic studies. Although these findings are nonspecific, they suggest the presence of diffuse neuronal dysfunction or loss in patients at the early stage of LNB [23]. Alba MA, Espgol-Frigol G, Prieto-Gonzlez S, et al. 3. Potential conflicts of interest. Department of Radiology, Medical University of Biaystok, Correspondence: Adam Garkowski, MD, Department of Radiology, Medical University of Biaystok, Poland, M. Skodowskiej-Curie 24A, 15-276 Biaystok (. The cerebrospinal fluid analysis revealed lymphocytic pleocytosis, and intrathecal Borrelia burgdorferi antibody production was confirmed; 1H-MRS spectrum shows marked elevation of choline and relative decrease of N-acetylaspartate indicating inflammation. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Unilateral cranial nerve palsy is more common than bilateral palsy, although multiple cranial nerves can be affected. Transmission occurs after the bite of ticks infected with bacteria (the 3 common species: Ixodes ricinus, Ixodes persulcatus, and Ixodes scapularis). Inflammatory features revealed in the CSF examination were as follows: pleocytosis, 136 cells/mm3 (91% lymphocytes); and protein, 0.801 g/L. The basis for these symptoms remains to be defined but may be the result of a vasculitis or Later, further medical history revealed that the patient had a past history of tick bite (approximately 4 months earlier before noticeable symptoms). Neuro-lyme disease: MR imaging findings Lyme disease. According to guidelines of the IDSA and the AAN, the diagnosis depends on 3 different elements: the patient may have been exposed to Ixodes ticks in their endemic area, they present clinical symptoms that have been associated with LNB, and diagnostic testing (positive antibodies to B burgdorferi with or without positive B burgdorferi antibodies in the CSF) supports the diagnosis [9, 10]. G., El. Magnetic resonance imaging (MRI) of a 56-year-old woman with Lyme neuroborreliosis-associated myelitis presented with peripheral left facial nerve palsy, meningitis, and decreased sensation in the upper extremities. Disease manifestations can be multisystem and nonspecific includes 1,2,4,5: Intracranial MR imaging findings in patients with Lyme disease are rare 2. From our many years of experience we observed this radiological manifestation only in one patient with LNB in the spinal cord (Figure 3). Axial Brain MRI with annotations of major structures. (A) Fluid-attenuated inversion recovery (FLAIR) image shows focal hyperintense lesion in the white matter of the left frontal lobe. (A) Fluid-attenuated inversion recovery (FLAIR) image, and (B) T2-weighted image shows numerous, mainly ovoid, hyperintense, periventricular white matter lesions perpendicular to the body of the lateral ventricle, initially assumed to be demyelination. J Pediatr 2016;170:334-e1. The patient was a 28-year-old female, previously healthy but with a history of tick bite. Involvement of other cranial nerves rarely occurs. Magnetic resonance imaging (A and B) and proton magnetic resonance spectroscopy (1H-MRS) (C and D) of a 32-year-old man with right facial nerve palsy and meningitis in the course of Lyme neuroborreliosis. Unable to process the form. Antibodies to immunodominant antigens were identified owing to the immunoblot analysis (Virotech, Rsselsheim, Germany). Abstract Objectives: Lyme disease is an infectious disease that frequently involves the central nervous system, leading to cognitive and/or mood dysfunction.