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Findings on Magnetic Resonance Imaging in Neuroborreliosis—A Nationwide Cohort Study
Journal article   Open access   Peer reviewed

Findings on Magnetic Resonance Imaging in Neuroborreliosis—A Nationwide Cohort Study

Mathilde Ørbæk, Nitesh Shekhrajka, Rosa Maja Møhring Gynthersen, Jacob Bodilsen, Lykke Larsen, Merete Storgaard, Christian Brandt, Lothar Wiese, Birgitte Rønde Hansen, Hans R. Luttichau, …
European journal of neurology, Vol.33(2), e70500
02/01/2026
DOI: 10.1111/ene.70500
PMCID: PMC12884127
PMID: 41657077
url
https://doi.org/10.1111/ene.70500View
Published (Version of record) Open Access

Abstract

Objective To explore pathological findings on magnetic resonance imaging (MRI) and their diagnostic implications in early-stage neuroborreliosis (NB). Method Adult patients from the Danish neuroinfections cohort (DASGIB, 2015–2019) with confirmed NB, symptom duration < 6 months, and MRI performed within 14 days of diagnosis were included. MRIs were retrospectively reinterpreted by an unblinded neuroradiologist. Results In 116 patients, 123 MRIs were performed (99 brain, 44 spine, 46 with contrast). White matter lesions (WML) were common, but non-specific and associated with increasing age (p < 0.001). Six patients showed WML not typical for small vessel disease. Acute infarctions occurred in four patients. Encephalitis was clinically diagnosed in five patients; one showed brainstem FLAIR hyperintensities. In 45 contrast-enhanced brain scans, leptomeningeal enhancement was identified in 6 (13%) and cranial nerve enhancement in 29 (64%). There was poor correlation between facial palsy and enhancement. Spinal cord lesions (1.6–14 cm) were identified in 10 of 44 scans (23%) without symptoms of transverse myelitis. Among 13 contrast-enhanced spine scans, 8 showed leptomeningeal enhancement (61%), and 8 showed nerve root enhancement (61%). Most enhancements did not match symptoms. Conclusion Pathological findings were found in 35 of 46 patients with contrast-enhanced MRIs. Key findings included cranial nerve, spinal nerve root, and leptomeningeal enhancement—often without clinical correlation. Spinal cord lesions were relatively frequent; cerebral infarction was rare. While key findings can support the diagnosis, their absence does not exclude NB.
 Magnetic Resonance Imaging cranial nerve enhancement infarction leptomeningeal enhancement neuroborreliosis spinal cord lesions white matter lesions

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