Enhancement of cranial nerves in Lyme neuroborreliosis: incidence and correlation with clinical symptoms and prognosis

Abstract

Purpose Symptoms of cranial neuritis are a common presentation of Lyme neuroborreliosis (LNB). Imaging studies are scarce and report contradictory low prevalence of enhancement compared to clinical studies of cranial neuropathy. We hypothesized that MRI enhancement of cranial nerves in LNB is underreported, and aimed to assess the prevalence and clinical impact of cranial nerve enhancement in early LNB. Methods In this prospective, longitudinal cohort study, 69 patients with acute LNB were examined with MRI of the brain. Enhancement of cranial nerves III–XII was rated. MRI enhancement was correlated to clinical findings of neuropathy in the acute phase and after 6 months. Results Thirty-nine of 69 patients (57%) had pathological cranial nerve enhancement. Facial and oculomotor nerves were most frequently affected. There was a strong correlation between enhancement in the distal internal auditory canal and parotid segments of the facial nerve and degree of facial palsy (gamma = 0.95, p < .01, and gamma = 0.93, p < .01), despite that 19/37 nerves with mild-moderate enhancement in the distal internal auditory canal segment showed no clinically evident palsy. Oculomotor and abducens nerve enhancement did not correlate with eye movement palsy (gamma = 1.00 and 0.97, p = .31 for both). Sixteen of 17 patients with oculomotor and/or abducens nerve enhancement had no evident eye movement palsy. Conclusions MRI cranial nerve enhancement is common in LNB patients, but it can be clinically occult. Facial and oculomotor nerves are most often affected. Enhancement of the facial nerve distal internal auditory canal and parotid segments correlate with degree of facial palsy.

Serum neurofilament light chain associates with symptom burden in Lyme neuroborreliosis patients: a longitudinal cohort study from Norway

“…This is interesting in the light of a recent MRI-study of patients with LNB, performed by Lindland et al . [ 32 ]. They found that 51% (19/37) of the patients with MRI signs of facial nerve inflammation and 94% (16/17) of the patients with MRI signs of oculomotor/abducens nerve inflammation did not have clinical signs of corresponding cranial nerve palsies.…”

“…They found that 51% (19/37) of the patients with MRI signs of facial nerve inflammation and 94% (16/17) of the patients with MRI signs of oculomotor/abducens nerve inflammation did not have clinical signs of corresponding cranial nerve palsies. They conclude that subclinical cranial neuritis is to be expected in a substantial share of patients [ 32 ]. Eventually, the presence of subclinical cranial neuritis without corresponding symptoms can explain why we did not observe associations between sNfL levels and affection of cranial nerves.…”

Diagnostic Challenges of Lyme Neuroborreliosis in Inpatient Neurology: A Case Series

“…7 Imaging findings supportive of LNB include meningeal, leptomeningeal, or neural enhancement though prevalence of these findings varies. [11][12][13] A prospective cohort study of 368 Danish patients with LNB showed only 12%-14% of MRIs demonstrated findings of LNB, 12 but another prospective cohort study of 69 European LNB patients found 57% had cranial nerve enhancement. 13 Patients with longer duration of symptoms are more likely to have LNB findings on MRI, as in our cases.…”

“…[11][12][13] A prospective cohort study of 368 Danish patients with LNB showed only 12%-14% of MRIs demonstrated findings of LNB, 12 but another prospective cohort study of 69 European LNB patients found 57% had cranial nerve enhancement. 13 Patients with longer duration of symptoms are more likely to have LNB findings on MRI, as in our cases. 12 However, there is frequently lack of correlation between enhancement of cranial nerves or nerve roots and neurologic symptoms, which was also seen in our three cases.…”

Assessment of cognitive function, structural brain changes and fatigue 6 months after treatment of neuroborreliosis

“…Some find reduced cognitive function, especially in verbal learning and memory [10][11][12], and processing speed [12,13], while others find no differences between patients and healthy controls [14,15]. Apart from leptomeningeal and cranial nerve enhancement in the acute phase, pathological findings on conventional MRI after treated neuroborreliosis are unusual [16][17][18]. MRI with high resolution and advanced image processing which allow quantification of cortical thickness and volume of brain regions has not been applied in patients with neuroborreliosis.…”