Department of Radiology, Sorlandet Hospital, Sykehusveien 1, N-4809, Arendal, Norway.
Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Neuroradiology. 2022 Dec;64(12):2323-2333. doi: 10.1007/s00234-022-02957-2. Epub 2022 May 24.
Symptoms of cranial neuritis are a common presentation of Lyme neuroborreliosis (LNB). Imaging studies are scarce and report contradictory low prevalence of enhancement compared to clinical studies of cranial neuropathy. We hypothesized that MRI enhancement of cranial nerves in LNB is underreported, and aimed to assess the prevalence and clinical impact of cranial nerve enhancement in early LNB.
In this prospective, longitudinal cohort study, 69 patients with acute LNB were examined with MRI of the brain. Enhancement of cranial nerves III-XII was rated. MRI enhancement was correlated to clinical findings of neuropathy in the acute phase and after 6 months.
Thirty-nine of 69 patients (57%) had pathological cranial nerve enhancement. Facial and oculomotor nerves were most frequently affected. There was a strong correlation between enhancement in the distal internal auditory canal and parotid segments of the facial nerve and degree of facial palsy (gamma = 0.95, p < .01, and gamma = 0.93, p < .01), despite that 19/37 nerves with mild-moderate enhancement in the distal internal auditory canal segment showed no clinically evident palsy. Oculomotor and abducens nerve enhancement did not correlate with eye movement palsy (gamma = 1.00 and 0.97, p = .31 for both). Sixteen of 17 patients with oculomotor and/or abducens nerve enhancement had no evident eye movement palsy.
MRI cranial nerve enhancement is common in LNB patients, but it can be clinically occult. Facial and oculomotor nerves are most often affected. Enhancement of the facial nerve distal internal auditory canal and parotid segments correlate with degree of facial palsy.
颅神经炎的症状是莱姆神经Borreliosis（LNB）的常见表现。影像学研究很少，与颅神经病的临床研究相比，报告的增强发生率较低且相互矛盾。我们假设 LNB 中的颅神经 MRI 增强被低估了，并旨在评估早期 LNB 中颅神经增强的发生率和临床影响。
在这项前瞻性、纵向队列研究中，对 69 例急性 LNB 患者进行了大脑 MRI 检查。对颅神经 III-XII 的增强进行了评分。MRI 增强与急性和 6 个月后的神经病变的临床发现相关。
69 例患者中有 39 例（57％）存在病理性颅神经增强。面神经和动眼神经最常受累。尽管远端内听道段和面神经腮腺段的轻度至中度增强有 19/37 根神经，但面神经的远端内听道段和腮腺段的增强与面瘫的程度之间存在很强的相关性（γ=0.95，p<0.01 和γ=0.93，p<0.01），但无明显的面瘫。动眼神经和展神经的增强与眼球运动麻痹无关（γ=1.00 和 0.97，均 p=0.31）。17 例动眼神经和/或展神经增强的患者中，有 16 例无明显的眼球运动麻痹。
MRI 颅神经增强在 LNB 患者中很常见，但可能是临床隐匿性的。面神经和动眼神经最常受累。面神经远端内听道和腮腺段的增强与面瘫的程度相关。
