title: Brainstem abnormalities and vestibular nerve enhancement in acute neuroborreliosis.
abstract: BACKGROUND
  Borreliosis is a widely distributed disease. Neuroborreliosis may present with unspecific symptoms and signs and often remains difficult to diagnose in patients with central nervous system symptoms, particularly if the pathognomonic erythema chronica migrans does not develop or is missed. Thus, vigilance is mandatory in cases with atypical presentation of the disease and with potentially severe consequences if not recognized early. We present a patient with neuroborreliosis demonstrating brain stem and vestibular nerve abnormalities on magnetic resonance imaging.
  
  
  METHODS
  A 28-year-old Caucasian female presented with headaches, neck stiffness, weight loss, nausea, tremor, and gait disturbance. Magnetic resonance imaging showed T2-weighted hyperintense signal alterations in the pons and in the vestibular nerves as well as bilateral post-contrast enhancement of the vestibular nerves. Serologic testing of the cerebrospinal fluid revealed the diagnosis of neuroborreliosis.
  
  
  CONCLUSIONS
  Patients infected with neuroborreliosis may present with unspecific neurologic symptoms and magnetic resonance imaging as a noninvasive imaging tool showing signal abnormalities in the brain stem and nerve root enhancement may help in establishing the diagnosis.
authors.affiliation: Diagnostic and Interventional Radiology Department, University Hospital of Zurich, Raemistrasse 100, Zurich 8091, Switzerland. nadja.amacker@usz.ch.
authors.forename: Nadja A
authors.initials: NA
authors.lastname: Farshad-Amacker
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D000208:Acute Disease; D000328:Adult; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D001933:Brain Stem / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D014725:Vestibular Nerve / Q000473:pathology* / Q000503:physiopathology