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Open Access Highly Accessed Case Report

Brainstem abnormalities and vestibular nerve enhancement in acute neuroborreliosis: a case report

Nadja A Farshad-Amacker*, Hans Scheffel, Thomas Frauenfelder and Hatem Alkadhi

Author Affiliations

Diagnostic and Interventional Radiology Department, University Hospital of Zurich, Raemistrasse 100, Zurich 8091, Switzerland

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BMC Research Notes 2013, 6:551  doi:10.1186/1756-0500-6-551

Published: 21 December 2013

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.

Case presentation

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.

Conclusion

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.

Keywords:
Borreliosis; Brain stem; MRI; Neuroborreliosis; Vestibular nerve enhancement