Dr. Nene Devavrat Harihar
Neurology
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Patient's Query
Hi doctor,
Could you tell me what is the lesion in my clivus or the spot near my cerebellum? My current symptoms are pain, instability, confusion, difficulty in concentrating, thinking and personality changes. I do not know if there is a relation with the lesion in the clivus, or the borrelia infection, the spot near my cerebellum, and the high monocyte count on my blood result (11.8%).
Hello,
Welcome to icliniq.com. I went through the reports (attachment removed to protect patient identity). Chronic neuroborreliosis can present with an intracranial space-occupying lesion that mimics tumors. This also looks like a chronic borrelial lesion to me, provided serology is positive for Borrelia. The high monocyte count is indeed well described in chronic borrelial infection.
Patient's Query
Thank you doctor,
What do you think the lesion in the clivus is? Can it be a chordoma, chondrosarcoma, fibrous dysplasia or osteomyelitis? Do you think the spot at the cerebellum is an infarct? If not, why not? Is it a collection of Borrelia bacteria? Is it an abscess or a cyst?
Hello,
Welcome back to icliniq.com. I am not convinced about the presence of any lesion in the cerebellum. Whatever is pointed in the sag sections with a red arrow looks like a vascular flow void. There is no evidence of a restriction on DWI (diffusion-weighted imaging). There is no evidence of infarction. The clival lesion is hypo on T1 and T2 without any contrast enhancement. Chordoma will be a brightly enhanced invading lesion. BNEC is another possibility but T2 is hypo here. So, that is unlikely. It does not appear like an abscess as well as there is no contrast enhancement. I think MRS (magnetic resonance spectroscopy) may help but, do get a radiology consult on this one.
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Neurology
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