E1550. To Evaluate the Clinical and Neuroimaging Features of Lyme Disease in Children at Magnetic Resonance Imaging of the Brain
  1. Aparna Tompe; Geisinger Medical Center
  2. Gino Mongelluzzo; Geisinger Medical Center
  3. Kiran Sargar; Geisinger Medical Center
To evaluate the clinical and neuroimaging features of Lyme disease in children at magnetic resonance imaging of the brain.

Materials and Methods:
In this institutional review board approved and HIPAA compliant study, we retrospectively reviewed the clinical and MRI brain imaging features of pediatric Lyme disease patients seen from Jan 2004 to December 2019 at our institution. The diagnosis of Lyme disease was confirmed based upon clinical features and serological tests.

A total 100 pediatric patients (age range = 2.5-18 years) with proven Lyme disease who underwent MRI of brain were included. MRI was normal in 72 patients. Five patients had findings on brain MRI non-attributable to Lyme disease. MRIs of eight patients revealed single or multiple punctate T2/FLAIR hyperintense lesions in cerebral white matter. Three patients had non-enhancing patchy T2/FLAIR hyperintense lesions in cerebral white matter mimicking multiple sclerosis. Among these, one patient showed a single non-enhancing patchy T2/FLAIR hyperintense lesion at the genu of the corpus callosum and adjacent frontal white matter. One patient showed multiple non-enhancing patchy T2/FLAIR hyperintensities in the right parietal cortex and subcortical white matter. Five patients demonstrated bilateral papilledema on MRI. Five patients showed abnormal cranial nerve enhancement including bilateral facial nerves (3), unilateral facial nerve (2), unilateral trigeminal nerve (2), unilateral oculomotor nerve (1), and unilateral abducens nerve (1). One patient showed abnormal leptomeningeal enhancement.

MRI brain imaging is often normal in pediatric Lyme disease patients with neurological symptoms. Some patients may show abnormal cranial nerve enhancement, papilledema, patchy T2/FLAIR hyperintense lesions in cerebral white matter and leptomeningeal enhancement, which are most likely attributable to Neuro-Lyme disease. Single or multifocal non-enhancing punctate T2/FLAIR cerebral white matter hyperintensities seen in pediatric patients with Lyme disease are likely non-specific. To our best knowledge, our pediatric specific study includes largest number of pediatric patients with Neuro-Lyme disease and provides comprehensive brain MRI features of Lyme disease in children.