Case 7
History:
35 year old male with multiple cranial neuropathy and headaches
Findings:
Axial enhanced T1WI showing enhancement of the left 7th nerve, bilateral 5th nerves, 10 and 11 nerve complex. FLAIR shows multiple punctuate areas of white matter hyperintensity signal.
Diagnosis:
Lyme disease
Discussion:
Lyme disease is an infection caused by the spirochete Borrelia burgdorferi, transmitted by the deer tick. Clinically the disease begins as a characteristic rash centered on the tick bite known as erythema chronicum migrans. Systemic dissemination is often manifested by flu-like symptoms and diffuse cutaneous lesions. At a later stage there is development of neurologic, ocular and arthropathic symptoms. The disease may also affect the heart resulting in conduction abnormalities and/or transient myopericarditis. Neurologic symptoms/signs develop in 10-15 percent of patients one to four months after inoculation and include peripheral neuropathy, radiculopathy, myelopathy, meningitis, movement disorders, and pain syndromes.
Imaging findings may simulate a demyelinating process such as MS or ADEM, with involvement of subcortical white matter, brainstem, and basal ganglia. Ring enhancement has been reported, as has cranial neuritis or leptomeningitis. Response to multiple antibiotic therapy is best if initiated early in the course of the disease.
