Does Lyme Disease Show Up on MRI? Brain Lesions and Cognitive Symptoms
Routine MRI findings may be normal
Brain lesions can be nonspecific
Advanced imaging may reveal hidden changes
Many patients ask whether Lyme disease shows up on MRI or causes brain lesions. The answer is complicated. Routine MRI scans may appear normal even when patients report brain fog, headaches, memory problems, cognitive slowing, or other neurologic symptoms.
Because MRI findings may be normal or nonspecific, imaging alone generally cannot confirm or exclude Lyme disease.
Researchers have explored whether advanced imaging techniques may identify subtle brain changes that routine scans miss. Magnetic resonance spectroscopy (MRS) is one example of an imaging approach being investigated for cognitive impairment and neurologic dysfunction.
Multiple studies indicate that neurotransmitter levels can be “related to measures of behavioral outcomes, such as memory, reaction timing,” writes Oeltzschner in the journal Neurobiology of Aging. “These relationships can be region-specific.” Their results might lead to new insights into cognitive impairment and neurologic symptoms in Lyme disease patients.
Measuring these levels, he adds, “could be a promising way to find out more about the inner workings of the disease and how it proceeds.”
Tognarelli agrees, writing, “Magnetic resonance spectroscopy (MRS) provides a non-invasive ‘window’ on biochemical processes within the body.”²
“The clinical use of in vivo magnetic resonance spectroscopy (MRS) has been limited for a long time, mainly due to its low sensitivity,” explains Marinette van der Graaf.³
“However,” she points out, “with the advent of clinical MR systems with higher magnetic field strengths such as 3 Tesla, the development of better coils, and the design of optimized radio-frequency pulses, sensitivity has been considerably improved.”
Why routine MRI scans may miss Lyme-related symptoms
Routine MRI studies evaluate structural abnormalities, but many Lyme-related symptoms may reflect functional, inflammatory, immune-mediated, or metabolic changes that are not easily visualized on conventional imaging.
This may explain why some patients with significant cognitive symptoms, brain fog, or neurologic Lyme disease symptoms have normal MRI findings.
Brain lesions seen on MRI are often nonspecific and may overlap with findings seen in migraine, aging, vascular disease, multiple sclerosis, or other neurologic conditions.
What advanced imaging studies have found
A study by Oeltzschner and colleagues looked at 13 people with mild cognitive impairment and found significant differences in several neurotransmitter levels relative to total creatine (tCr) when compared to healthy controls.
Results indicated patients with mild cognitive impairment had:
- Decreased levels of γ-aminobutyric acid (GABA)
- Decreased levels of glutamate (Glu)
- Decreased levels of N-acetylaspartate (NAA)
- Increased levels of inositol (mI)
Oeltzschner from The Johns Hopkins University School of Medicine recommended additional studies “to improve the understanding of the regional specificity of brain metabolite changes and their effects on different domains of cognitive function.”
Advanced imaging remains investigational for many Lyme-related neurologic complaints. Patients with persistent cognitive symptoms may also require evaluation for neuropsychiatric symptoms, sleep disorders, autonomic dysfunction, and co-infections.
Editor’s Note: Could measuring neurotransmitter levels eventually help explain cognitive impairment in Lyme disease patients? More research is needed.
Frequently Asked Questions
Does Lyme disease show up on MRI?
Routine MRI scans may be normal in many Lyme disease patients. When abnormalities appear, they are often nonspecific and may overlap with findings from other neurologic conditions.
Can Lyme disease cause brain lesions?
Some patients with neurologic Lyme disease may have white matter abnormalities or nonspecific lesions on MRI, but these findings are not unique to Lyme disease.
Why can MRI scans be normal despite symptoms?
Many neurologic symptoms may reflect inflammatory, metabolic, or functional changes that conventional MRI cannot easily detect.
What imaging may help evaluate cognitive symptoms?
Advanced techniques such as magnetic resonance spectroscopy may provide additional information about brain metabolism and neurotransmitter changes, though these tools remain primarily research-based.
Clinical Takeaway
Routine MRI findings may be normal even when patients experience significant cognitive symptoms. Advanced imaging techniques such as MRS may eventually improve understanding of neurologic dysfunction, but diagnosis still depends primarily on clinical assessment and supporting evidence.
Persistent cognitive symptoms deserve evaluation even when imaging appears unrevealing.
Related Articles
What happens to the brain during acute Lyme neuroborreliosis?
Brain fog and Lyme disease
Neurologic Lyme disease
Neuropsychiatric Lyme disease
References
- Oeltzschner, G. et al. Neurometabolites and associations with cognitive deficits in mild cognitive impairment: a magnetic resonance spectroscopy study at 7 Tesla. Neurobiol Aging. 2019 Jan;73:211-218.
- Joshua M. Tognarelli. Magnetic Resonance Spectroscopy: Principles and Techniques: Lessons for Clinicians. J Clin Exp Hepatol. 2015 Dec;5(4):320–328.
- Marinette van der Graaf. In vivo magnetic resonance spectroscopy: basic methodology and clinical applications. Eur Biophys J. 2010 Mar;39(4):527–540.
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
