FLAIR and magnetization transfer imaging of patients with post-treatment Lyme disease syndrome.
OBJECTIVE
To determine patterns of abnormalities on cerebral MRI that may characterize subgroups of patients with post-treatment Lyme disease syndrome (PTLDS) and to help identify pathomechanisms of disease.


METHODS
The authors analyzed the distribution of cerebral lesions in a cohort of 27 patients with PTLDS. A subgroup of eight patients with PTLDS was further studied using whole-brain magnetization transfer ratio measures to identify abnormalities not seen on T2-weighted images.


RESULTS
Four patients had focal neurologic deficits, relapsing-remitting disease, and lesions in a distribution typical of MS. Twenty-three patients presented with nonfocal symptoms such as fatigue, subjective memory deficits, and mood disturbance. Twelve of these patients had normal MRI, including the more sensitive fluid-attenuated inversion recovery sequence, 10 had primarily punctate and subcortical lesions, and one patient had multiple periventricular lesions.


CONCLUSIONS
In a portion of patients with post-treatment Lyme disease syndrome, white-matter hyperintensities tend to occur in subcortical arteriolar watershed areas and are not specific. Magnetization transfer ratio analysis did not provide evidence for structural abnormalities of the brain parenchyma in patients with nonfocal disease.
Morgen
K
K
Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1400, USA.
Martin
R
R
Stone
R D
RD
Grafman
J
J
Kadom
N
N
McFarland
H F
HF
Marques
A
A
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology; D001925:Brain Damage, Chronic / Q000175:diagnosis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D020852:Lyme Neuroborreliosis / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents