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.

[bctt tweet=”Normal radiologic findings should not be a reason to rule out neurologic Lyme disease. ” username=”DrDanielCameron”]

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.

9 Replies to "Brain MRI in Lyme disease"

  • Amy Barron
    03/08/2024 (11:53 pm)

    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.

  • Laura Slowikowski
    03/03/2024 (11:36 pm)

    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 positive it’s lymes

    • Dr. Daniel Cameron
      03/04/2024 (7:39 am)

      The test are not as reliable as I would like. I have had to treat using clinical judgement if the tests are negative.

  • Jacqueline Smith
    10/24/2023 (11:37 am)

    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

    • Dr. Daniel Cameron
      10/25/2023 (7:55 am)

      Numbness can occur in Lyme and diabetes. I have had patients in my practice with both.

  • Jim Lewis
    02/10/2023 (12:40 pm)

    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,

    • Dr. Daniel Cameron
      02/13/2023 (1:07 pm)

      White spots on an MRI are from so many causes. I advise my patients to be reassessed for tick borne illness including Babesia.

    • Charity Kresge
      03/24/2023 (1:21 am)

      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. ❤️🙏🏼✨

    • Amy Barron
      03/11/2024 (3:11 am)

      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.

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