Enzephalitis

Imaging in

Lyme neuroborreliosis. LNB encephalitis in a 40-year-old woman. She presented with 1 day history of headache, vomiting, dizziness and personality change. The CSF cell count was 182 cells/mm3. MRI showed symmetric diffuse and patchy T2 (a) and FLAIR (b, c) hyperintensity of inferior thalami (arrows in a), cerebral peduncles, mesencephalon, pons (arrows in b) and cerebellar dentate nuclei (arrows in c). There were no abnormalities on diffusion-weighted or post-contrast images (not shown). Further clinical and laboratory investigations revealed erythema migrans on the right thigh and a positive CSF Bb IgG AI. Tests for TBE antibodies were negative. She received antimicrobial treatment, and repeated MRI 8 weeks after the initial scan was normal (d–f)