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Insights Imaging. 2018 Oct;9(5):833-844. doi: 10.1007/s13244-018-0646-x. Epub 2018 Sep 4.

Imaging in Lyme neuroborreliosis.

Author information

1
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. elisalindland@gmail.com.
2
Department of Radiology, Sorlandet Hospital, Sykehusveien 1, N-4809, Arendal, Norway. elisalindland@gmail.com.
3
Institute of Clinical Medicine, University of Oslo, Oslo, Norway. elisalindland@gmail.com.
4
Department of Neurology, Sorlandet Hospital, Kristiansand, Norway.
5
Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
6
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
7
Addiction Unit, Sorlandet Hospital, Arendal, Norway.
8
Department of Infectious Diseases, Oslo University Hospital, Ullevaal, Norway.
9
The Norwegian National Advisory Unit on Tick-Borne Diseases, Sorlandet Hospital, Arendal, Norway.
10
Department of Neurology, Oslo University Hospital, Oslo, Norway.
11
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
12
Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.

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.

KEYWORDS:

Encephalitis; Lyme neuroborreliosis; MRI; Myelitis; Neuritis

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