A 70-year-old male presents with several weeks of progressive fatigue, difficulty concentrating, and mood changes. He has a history of Lyme disease a year ago, which was treated with antibiotics. A brain MRI shows white matter hyperintensities. What could be the diagnosis, and what is the treatment plan?
The patient's history and MRI findings raise the possibility of Lyme encephalopathy, a rare complication of Lyme disease, which can manifest with cognitive changes and abnormal findings on brain MRI. Other causes of white matter hyperintensities, such as small vessel disease or demyelinating diseases, should also be considered. If Lyme encephalopathy is suspected, a lumbar puncture for cerebrospinal fluid analysis can be considered to confirm the diagnosis. The management typically involves a course of intravenous antibiotics.