Brain MRI in Lyme disease

Infectious pathogens, including viral, bacterial and parasitic, can impact the central nervous system (CNS), resulting in neurologic disease. “The infections caused by these pathogens often show a variety of neuroimaging patterns that can be identified [on a] CT scan and MRI,” explains Alves Simão and colleagues. ¹ Radiology, they argue, is central to the diagnosis and follow-up of these conditions. Therefore, “radiologists should be familiar with these infections.”


The authors review the role of medical imaging for various infectious diseases including the Zika virus, measles, influenza, Chagas disease, syphilis, and Lyme disease. The authors include a discussion of a brain MRI in Lyme disease.

Although it is uncommon, Lyme disease patients have presented with positive radiologic findings, writes Alves Simão. Test results, however, are often non-specific.

Several studies have identified brain imaging abnormalities in Lyme disease patients that resemble those found in individuals with multiple sclerosis. MRI tests have shown “multiple bilateral foci of T2 hyperintensity in the periventricular or subcortical white matter” in Lyme disease patients.

Normal radiologic findings should not be a reason to rule out neurologic Lyme disease. Click To Tweet

In addition, the fluorodeoxyglucose PET (FDG-PET) scan has revealed “two distinct patterns of brain hypometabolism in patients with Lyme disease: specific temporal lobe hypometabolism and diffuse cortical hypometabolism,” the authors write.

Although there is “no clear diagnostic pattern,” memory disturbances are associated with the temporal lobes. And the FDG-PET scan “may show the affected areas in patients who present with neurologic involvement of Lyme disease.”

Other neurological findings

Furthermore, MRI tests have identified “thin non-nodular nerve enhancement” in patients with facial nerve palsy, the authors write. “A protocol similar to that described to evaluate cranial nerve involvement of neurosyphilis may be applied to patients with Lyme disease.”

These findings can be seen in idiopathic palsies, including Bell’s palsy. “Lyme disease-related facial nerve palsy may be indistinguishable from idiopathic facial palsies and palsies from other causes at imaging,” the authors point out.

Meanwhile, the “enhancement of meninges and cranial or spinal nerves” has been seen by MRI in meningoradiculitis due to Lyme disease. Meningeal enhancement is also found in patients with both inflammatory and non-inflammatory conditions, Alves Simão explains.

Radiological imaging can help in differentiating between direct central nervous system damage and secondary encephalopathy, the authors conclude.

Unfortunately, most “CT and MRI findings of the brain and spine in patients with Lyme disease are often within normal limits, even among patients with known neurological manifestations,” writes Alves Simão.

However, “normal [radiological] findings should not be a reason to rule out the diagnosis, especially if the clinical and epidemiologic contexts are compatible.”

  1. Alves Simão AK, Amaral LLFD, Inada BSY, Silveira CF, Campos CMS, Freitas LF, Bonadio V, Marussi VHR. Neuroimaging of Emergent and Reemergent Infections. Carmo RLD. Radiographics. 2019 Oct;39(6):1649-1671.

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Jim Lewis
Jim Lewis
3 months ago

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,

Charity Kresge
Charity Kresge
2 months ago
Reply to  Jim Lewis

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. ❤️🙏🏼✨