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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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NEUROIMAGING FINDINGS IN LYME DISEASE – A PICTORIAL REVIEW

Teresa P. Morais, Catarina Perry da Camara; Carolina Pinheiro; Joana Ramalho; Carla Conceição; Jaime Pamplona

Neuroradiology Department, Hospital Dona Estefânia, Hospital São Jose e Hospital Santo Antonio Capuchos, Centro Hospitalar de Lisboa Central (CHLC)

- Congresso Nacional SPNR, 1 a 4 de junho 2017, Estarreja

Background: Lyme disease is a multisystemic disease with a worldwide distribution caused by spirochete Borrelia species and transmitted by ixodid ticks. It may affect several organs and systems such as skin, joints, heart, eye, and nervous system. Approximately 30% of Lyme disease occurs in children. Neurologic involvement occurs in about 10-15% of patients with systemic infection and is commonly known as Lyme neuroborreliosis (LNB). The definitive diagnosis of LNB requires evidence of possible exposure, signs and symptoms of nervous system disease, and supportive laboratory data, which include screening with ELISA followed by the more specific Western blot analysis. MRI is the imaging method of choice for evaluation of the brain and spine in LNB. Treatment consists of intravenous antibiotic.
Objectives: The purpose of this presentation is to review the clinical and magnetic resonance imaging (MRI) findings of LNB, with special focus on pediatric patients.
Methods: Our population consisted of 5 patients (4 male; 1 female; age range, 11 to 31 years, mean age, 16.8 years). In all cases, LNB was confirmed by ELISA and Western blot test in all patients. Clinical and MRI findings of LNB were reviewed. 
Results: The clinical symptoms of LNB included meningitis, cranial neuritis and/or cranial nerve palsies, radiculoneuritis, and encephalitis and/or encephalomyelitis. A common presentation in children was facial nerve palsy with or without meningitis. The most frequent imaging findings were nonspecific white matter foci involving both hemispheres and meningeal and cranial nerve enhancement. Spinal cord lesions were seen in children.
Conclusion: Lyme neuroborreliosis is not rare and children are commonly affected. The characteristic MRI findings and clinical findings may be slightly different in children. These findings should be recognized by the radiologist to assure LNB appropriate diagnosis and clinical management.

Palavras Chave: Imaging; Lyme disease; MRI; neuroborreliosis;