Neuroborreliosis: Unusual clinical presentation and imaging features

Lyme disease is a tick-borne infectious disease caused by Borrelia burgdorferi which causes a multi-organ involvement. It is endemic in North America and Europe, but not very commonly seen in India. Neurological manifestations (Lyme's Neuroborreliosis,) can occur in both the early and late disseminated stages, and the classic triad consists of aseptic meningitis, painful radiculoneuritis, and cranial neuropathy. If untreated, it can be fatal and may lead to significant morbidity. We report a case with neuroborreliosis who developed acute onset and rapidly progressive bilateral vision loss, and we also report characteristic features on neuroimaging, including a characteristic "rounded M sign." This unusual presentation, along with the characteristic imaging features, should be borne in mind to avoid misdiagnosis.