Teaching NeuroImage: Pontine Owl-Eyes Lesions in a Case of Neuroborreliosis

Brain MRI in a 65-year-old woman with headache, sensory ataxia, and tick exposure revealed leptomeningeal and cranial nerve enhancement and T2-hyperintense symmetrical pontine lesions resembling the “owl-eyes” sign, a radiologic finding described in ischemic or compressive myelopathy (Figure, A–C).1CSF analysis revealed pleocytosis (163/µL) and intrathecal production of anti-BorreliaIgG (CSF/serum index 21, N < 2). Workup was negative for alternative causes. The patient fully recovered after 21 days of ceftriaxone (Figure, D–F).