Imaging in Lyme neuroborreliosis

Abstract

Lyme neuroborreliosis (LNB) is a tick-borne spirochetal infection with a broad spectrum of imaging pathology. For individuals who live in or have travelled to areas where ticks reside, LNB should be considered among differential diagnoses when clinical manifestations from the nervous system occur. Radiculitis, meningitis and facial palsy are commonly encountered, while peripheral neuropathy, myelitis, meningoencephalitis and cerebral vasculitis are rarer manifestations of LNB. Cerebrospinal fluid (CSF) analysis and serology are key investigations in patient workup. The primary role of imaging is to rule out other reasons for the neurological symptoms. It is therefore important to know the diversity of possible imaging findings from the infection itself. There may be no imaging abnormality, or findings suggestive of neuritis, meningitis, myelitis, encephalitis or vasculitis. White matter lesions are not a prominent feature of LNB. Insight into LNB clinical presentation, laboratory test methods and spectrum of imaging pathology will aid in the multidisciplinary interaction that often is imperative to achieve an efficient patient workup and arrive at a correct diagnosis. This article can educate those engaged in imaging of the nervous system and serve as a comprehensive tool in clinical cases.Key Points• Diagnostic criteria for LNB emphasise exclusion of an alternative cause to the clinical symptoms.• MRI makes a crucial contribution in the diagnosis and follow-up of LNB.• MRI may have normal findings, or show neuritis, meningitis, myelitis, encephalitis or vasculitis.• White matter lesions are not a prominent feature of LNB.

Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease

“…With the exception of one study (121), all identified abnormalities in a subset of individuals within their respective samples. However, imaging studies in Lyme disease have more recently been called into question as a result of advances in imaging technology, knowledge of age-related white matter changes and potential overlap with the general population, and/or increased specificity of diagnostic criteria (126). Newer research techniques, such as those to image central nervous system inflammation using novel PET imaging (127), may aid diagnosis in the future and provide additional insight into the pathophysiology of persistent symptoms.…”

Brain miliary enhancement

“…Treatment of choice is based on antibiotics [48]. MRI rarely reveals brain lesions, but both meningeal and nerve root involvements are relatively common features [50,51]. Focal hyperintense T2 multiple sclerosis-like lesions of cerebral white matter have also been reported [50].…”

“…Spinal cord involvement by Borrelia burgdorferi, on the other hand, is very rare [52]. Cerebral vasculitis in neuro-Lyme disease can affect small-sized as well as medium-and large-sized intracranial arteries, a recent study report on predominant anterior circulation vasculitis in addition to reported PVS involvement [51].…”

Lyme Neuroborreliosis in a Patient with Breast Cancer: MRI and PET/CT Findings

“…Though adults with Lyme neuroborreliosis often manifest with a subacute painful meningoradiculitis and/or cranial nerve palsy, symptoms can appear in different stages and be clouded by comorbidities causing potential misdiagnoses and diagnostic delay. In these cases, imaging and especially MRI serve to assist with diagnosis [5]. A wide spectrum of imaging entities including diffuse affection in brain or spinal cord, meningeal and/or nerve enhancement and vascular affection has been demonstrated as well as overlap with findings consistent with multiple sclerosis [5][6][7][8].…”

“…A wide spectrum of imaging entities including diffuse affection in brain or spinal cord, meningeal and/or nerve enhancement and vascular affection has been demonstrated as well as overlap with findings consistent with multiple sclerosis [5][6][7][8]. Though none of these changes are pathognomonic for Lyme neuroborreliosis, they can serve as a contribution to diagnostics especially in case of nerval/meningeal enhancement, in which case lumbar puncture is recommended [5,9,10]. To our knowledge this is the first case presenting with definite Lyme neuroborreliosis where both MRI and 18 F-FDG PET/CT was performed within 48 hours.…”