PMC4528861_01
(A) MRI head: axial T1 weighted with contrast agent (August 2013): pathological enhancement of N. facialis on both sides in tympanal segment (arrows), expansion as far as Foramen stylomastoideum (not shown). (B) MRI head after treatment: axial T1 weighted with contrast agent (September 2013): enhancement of N. facialis in the tympanal segment is no longer detectable.
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MRI scan of the head showed gadolinium enhancement of the facial nerve on both sides (Figure 1A), and MRI of the vertebral spine revealed a strong contrast enhancement of the conus medullaris and fibers of the cauda equina (Figure 2A). Follow-up MRI scans of head and spine 6 weeks after initial presentation and after termination of antibiotic treatment demonstrated complete regression of the meningeal enhancement of both facial nerves and of the spinal cord (Figures 1B and 2B).
(A) MRI long spine T1 weighted with contrast medium (August 2013): enhancement of Conus medullaris and fibers of the Cauda equina (arrows), disseminated metastases of vertebral bodies. (B) MRI long spine after treatment (September 2013): T1 weighted with contrast agent: the former enhancement of Conus medullaris and Cauda equina can only minimally be seen any longer.
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MRI scan of the head showed gadolinium enhancement of the facial nerve on both sides (Figure 1A), and MRI of the vertebral spine revealed a strong contrast enhancement of the conus medullaris and fibers of the cauda equina (Figure 2A). Follow-up MRI scans of head and spine 6 weeks after initial presentation and after termination of antibiotic treatment demonstrated complete regression of the meningeal enhancement of both facial nerves and of the spinal cord (Figures 1B and 2B).
MRI head axial, FLAIR (August 2013): multiple unspecific gliosis spots in the white matter, seen bihemispheric, which can also occur due to neuroborreliosis, exemplarily 2 frontal lesions shown here (arrows).
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Therefore, we abandoned the diagnosis of a leptomeningeal carcinomatosis and concluded that all former neurological and MR tomographic abnormalities were due to a neuroborreliosis (see also Figure 3).