meningoencephalitis

Imaging in

Lyme neuroborreliosis. LNB meningoencephalitis in a 45-year-old female who presented with fatigue, headache, dizziness and vomiting. Neurological findings were tremor and unsteady gait. The CSF cell count was 270 cells/mm3 and there was a positive Bb IgG AI. Post-contrast sagittal (a) and axial (b) FLAIR images demonstrated patchy leptomeningeal enhancement over the cerebral convexities and in the posterior fossa (arrows). There was a hyperintense lesion in the left thalamus (arrow) on axial T2-weighted image (c) and coronal FLAIR image (d). There was no abnormality in the lesion on diffusion weighted images (not shown). Post-contrast axial (e) and coronal (f) T1-weighted images showed punctate and curvilinear uptake (arrows) in the thalamic lesion. Similar, subtle changes were present in the right thalamus. After 2 months there was only slight residual hyperintensity in the left thalamus (arrow) on axial FLAIR image (g) and no sign of enhancement on post-contrast axial T1 weighted image (h). One year after treatment there were no imaging abnormalities (i)