MRI is not helpful in diagnosis of Lyme disease. However, an MRI may be helpful in diagnosing neurologic manifestations of early and late disseminated Lyme disease. MRI scan in patients with neurological Lyme disease may demonstrate increased intensity in white matter at multiple foci on T2-weighted images, suggesting demyelination or inflammatory changes. After antibiotic therapy, spontaneous resolution of MRI white matter hyper-intensities has been observed in Lyme disease.

• Abnormal magnetic resonance imaging (MRI) findings are often seen in both early and late disseminated Lyme disease.^[1]
• MRI scans of patients with neurologic manifestations of Lyme disease may demonstrate increased intensity in white matter at multiple foci on T2-weighted images, suggesting demyelination or inflammatory changes.^[2]
• These changes are similar to those seen in demyelinating or inflammatory disorders such as multiple sclerosis or systemic lupus erythematosus (SLE).^[3]
• MRI scan of a few patients with neurologic manifestations of Lyme disease may show cerebral atrophy and brainstem neoplasm.^[4]
• MRI scan of a few patients with facial palsy may show enhancement of facial nerve.^[5]
• Diffuse white matter pathology can disrupt these ubiquitous gray matter connections and could account for deficits in attention, memory, visuospatial ability, complex cognition, and emotional status.
• White matter disease may have a greater potential for recovery than gray matter disease, perhaps because neuronal loss is less common in white matter disease.
• After antibiotic therapy, spontaneous resolution of MRI white matter hyper-intensities has been observed in Lyme disease.^[6]

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