MRI in Lyme Disease Reveals Source of Symptoms Like Hearing-Loss
A Lyme disease MRI may also provide an explanation for hearing loss for which there is no other apparent cause. Iero (et al, 2004) report on a patient with few clinical manifestations of Lyme disease but who showed lesions in the white matter of the subcortical periventricular region on an MRI. The authors suggest that testing for Lyme disease antibodies should occur in cases where unexplained leukoencephalopathy occurs as an isolated lesion of the eighth cranial nerve may constitute the only neurologic sign of Lyme disease. A case involving an eight year old child with Lyme disease, presented by Lebas (et al, 2010) also demonstrated the use of MRI scans. The patient had cerebral vasculitis and suffered a stroke due to Lyme neuroborreliosis, with ischaemic lesions (areas where blood flow was cut-off) in the pons and cerebellum. Lyme disease may be a rare cause of stroke in children but these researchers demonstrated that the use of a gadolinium-enhanced MRI was helpful in identifying abnormalities in brain blood vessels in a child with brainstem stroke. The child responded well to treatment and no basilar artery stenosis (narrowing) was evident nine months after treatment.
Cerebral Vasculitis and Lyme Neuroborreliosis
In a fatal case of undiagnosed Lyme disease in adult patient with neuroborreliosis, described in a report by Buchwald (et al, 2010), sudden onset of hemiparesis initially resolved in part and the patient was initially discharged following improvements. This 25yr-old smoker showed evidence of cerebral vasculitis with a small subcortical infarction revealed by an MRI and CT scan. The physicians discounted Lyme neuroborreliosis as a possible cause despite the patient having reported being bitten by a tick, as no other Lyme disease symptoms were present, such as erythema migrans, headache, fever, or joint pain. Five weeks after the patient was discharged, his condition degenerated and he developed dysphasia (inability to communicate) and paresis (weakness) of his left leg. At eight weeks he was given another MRI and CT scan with angiographic sequences and the doctors found an infarction in the area perfused by the left anterior cerebral artery and degeneration of the basilar artery, both middle cerebral arteries and the left anterior cerebral artery itself.
Accurate MRI Reading Saves Lives
Testing of this patient’s CSF revealed elevated protein and increased white blood cells and an ELISA test proved positive for Borrelia IgM-antibodies. Blood tests also proved positive for IgG-antibodies to Borrelia. PCR tests on the CSF were negative for Borrelia DNA however. The patient received doxycycline treatment for twelve days, along with intravenous methylprednisone for three days and oral prednisone after that but he continued to deteriorate and the vasculitis and ischaemia progressed. The patient died three weeks later following brain oedema and transtentorial and subfalcine herniation, which is where parts of the brain shift in the skull leading to a dangerous increase in intracranial pressure and potentially fatal ischaemia, as was the unfortunate case here. It is clear that better recognition of cerebral vasculitis as a possible sign of Lyme disease, even in the absence of other conditions, may lead to more rapid treatment intervention and a better Lyme disease prognosis in such cases.
Such an extreme case of an isolated symptom of Lyme neuroborreliosis is extremely rare and Buchwald (et al) speculate that it is the only recorded case in medical literature. The authors also note that the delay in seeking medical attention following the deterioration of the patient’s condition likely contributed to the fatal course of the disease, but that an index of suspicion should be employed, particularly in Lyme-endemic areas for both ‘cryptogenic’ stroke and cerebral vasculitis. The importance of correct application, and interpretation, of Lyme disease MRI scans should not be overlooked, as demonstrated by these cases.