Brain MRI in Lyme Disease: What Imaging May Reveal
Brain imaging can help evaluate neurological symptoms in Lyme disease. However, MRI findings are often nonspecific, and a normal brain MRI does not rule out neurologic Lyme disease.
Brain MRI and Neurologic Lyme Disease
Neurologic Lyme disease can affect the brain, spinal cord, and peripheral nerves. In some patients, brain imaging such as MRI may reveal abnormalities that help clinicians evaluate neurological symptoms.
Brain MRI is sometimes used when evaluating patients with suspected neurologic Lyme disease, particularly when symptoms include memory problems, facial palsy, neuropathy, or meningitis.
In their review of imaging findings in infectious diseases, Alves Simão and colleagues discuss the role of neuroimaging in conditions such as Zika virus, measles, influenza, Chagas disease, syphilis, and Lyme disease.
Although uncommon, Lyme disease patients may present with abnormalities on brain MRI. However, these findings are often nonspecific and must be interpreted alongside clinical symptoms and exposure history.
Several studies have identified brain imaging abnormalities in Lyme disease patients that resemble findings seen in multiple sclerosis. MRI scans may reveal multiple bilateral foci of T2 hyperintensity in the periventricular or subcortical white matter.
Because these lesions can appear similar to those seen in other neurologic disorders, imaging alone cannot establish a diagnosis of neurologic Lyme disease.
[bctt tweet=”Normal radiologic findings should not be a reason to rule out neurologic Lyme disease.” username=”DrDanielCameron”]
FDG-PET Imaging and Brain Function
Functional imaging may reveal abnormalities even when structural MRI appears normal.
Fluorodeoxyglucose PET (FDG-PET) scans have revealed two distinct patterns of brain hypometabolism in Lyme disease patients:
- Temporal lobe hypometabolism
- Diffuse cortical hypometabolism
The temporal lobes play an important role in memory and cognition. Abnormalities in these regions may help explain symptoms such as brain fog, slowed thinking, and memory impairment reported by many patients with neurologic Lyme disease.
While FDG-PET imaging is not routinely used to diagnose Lyme disease, it may reveal functional brain changes in patients with neurologic involvement.
Imaging Findings in Facial Nerve Palsy
MRI can also identify abnormalities affecting the cranial nerves.
In some patients with Lyme-related facial nerve palsy, MRI may demonstrate thin non-nodular nerve enhancement. A protocol similar to that used to evaluate cranial nerve involvement in neurosyphilis may be applied when Lyme disease is suspected.
However, imaging findings alone cannot distinguish Lyme disease from other causes of facial nerve palsy. Lyme-related facial paralysis may be indistinguishable from idiopathic palsies such as Bell’s palsy or facial nerve palsy caused by other conditions.
Meningeal and Nerve Enhancement
MRI may also reveal enhancement of the meninges or cranial and spinal nerves in patients with meningoradiculitis caused by Lyme disease.
Meningeal enhancement can be seen in both inflammatory and non-inflammatory conditions and is therefore not specific for Lyme disease.
Radiologic imaging can help clinicians differentiate between direct central nervous system damage and secondary encephalopathy.
Why Normal Imaging Does Not Exclude Lyme Disease
Perhaps the most important point emphasized by Alves Simão is that imaging studies are frequently normal in patients with neurologic Lyme disease.
CT and MRI scans of the brain and spine are often within normal limits, even among patients with confirmed neurological manifestations.
For this reason, normal radiologic findings should not be used to rule out Lyme disease when the clinical and epidemiologic context is compatible with infection.
In clinical practice, diagnosis often relies more heavily on the patient’s symptoms, exposure risk, and laboratory evaluation than on imaging alone.
Frequently Asked Questions
Can Lyme disease show up on an MRI?
Sometimes. Brain MRI in Lyme disease may show white matter abnormalities, nerve enhancement, or other nonspecific findings. However, imaging is frequently normal. A normal MRI does not rule out neurologic Lyme disease.
Related Articles:
Neurological damage/dysfunction found in early Lyme disease patients
References:
- Alves Simão AK, Amaral LLFD, Inada BSY, Silveira CF, Campos CMS, Freitas LF, Bonadio V, Marussi VHR. Neuroimaging of Emergent and Reemergent Infections. Radiographics. 2019;39(6):1649-1671.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Hi Dr Cameron, Was wondering can the findings of Microvascular ischemic and changes of white mater be caused by Lyme? I had a CT scan yesterday no contrast and a spinal tap no results on that yet it was compared to a CT from 6 months ago. I was straight positive on Lyme Elisa and Western blot nov 2021 may have had it sinse 2016 didn’t get right treatment then over the past summer Western blot only lost one of the bottom bands now that band is back been told I have active infection but don’t think 100mg doxy 2x a day and ivermectin is going to be enough trying to deal with Cleveland clinic Dr’s for the sever neurological symptoms is tough as they believe one treatment is enough! I’m currently being treated by ILADS Cnp but I’m not getting better .. Also had Babesia duncani 160 IgG IgeneX and a positive Bartonella from Mdl that said I was positive for 3 different species of Lyme.. Can Lyme cause these findings ? Having horrible neurological issues, nervousness, insomnia, emotional feeling of impending doom and confusion..
Thank you,
Jim
White spots on an MRI are from so many causes. I advise my patients to be reassessed for tick borne illness including Babesia.
Hey Jim,
I was diagnosed with Lyme a few weeks back and am also on a journey to figure all of this stuff out. I read your post and my heart went out to you as the last few years I’ve had the same horrible symptoms. It really is awful to feel so anxious, confused, and dark all the time! Especially when you have no idea why and you think you’re losing your mind (which is how it was for me since is didn’t know about the Lyme yet).
I just wanted to reach out and say you’re not alone on this tough, tough journey. I’m hoping for the best for you. ❤️ ✨
Hi Jim. I am wondering how you are making out. What treatments you’ve received. My husband currently is hospitalized in a BSU with paranoia and hallucinations…which all stemmed from insomnia, and I believe directly from Lyme. Awaiting results. He also has “mild small vessel ischemic areas” on his MRI. Thanks so much for your response.
God morning, When a doctor (Dr. Andrew Serpe, Amityville) finally figured out my problem with a blood test it was discovered that I had Lyme disease. How long I do not know. But my blood work showed 7 bars effected by lyme. I am now on gabapentin 300mg 3 times a day. I really don’t believe in or want to take drugs. But the numbing and pain in my feet is getting worse . If I had to guess I was bite 20-25 years before diagnoses, which was 3 years ago. Is this like diabetes where I will be loosing my toes ?? If you can not help me can you recommend someone ?? I hope you will read this and help me. I am a 70 year old very active women. Thank you for your kindness Jacqueline Smith
Numbness can occur in Lyme and diabetes. I have had patients in my practice with both.
I had a huge tick in ear for 9 months when found doc through it away,I have had 4 MRI done and no one saw it? I’m sooo sick and waiting for results.im positive it’s lymes
The test are not as reliable as I would like. I have had to treat using clinical judgement if the tests are negative.
Hi dr. Cameron. My husband is 43 years old, no history of mental health issues, and over the past week, he has had increasing paranoia, and started hallucinating. MRI revealed “ BRAIN PARENCHYMA: There are scattered foci of signal abnormality in a
bifrontal distribution suggestive of sequelae of prior
headaches/migraines or early chronic small vessel ischemic disease.”. Doctor sent out Lymes panels and not back yet. Do you have any insight on this? Any help is greatly appreciated. I need my husband back. Thanks so much.
Hemp Dr Cameron. Was wondering about the effects of tick borne disease on having flares in the T2 area? Can you explain this maybe? Thanks
Tick-borne illness can involve neurologic and musculoskeletal symptoms, but focal flares need clinical evaluation rather than assumptions.