Neurobrucellosis: magnetic resonance findings

Abstract

Introdution: brucellosis is an bacterian zoonosis, caused by Brucella gender, it is responsable about 500 000 human infections per year in the world. Brucelosis is a multisystemic infection with a variable clinic spectre. Neurobrucellosis is a condition that involves the central nervous system, as complication of systemic disease in about 5-7% of the cases with brucellosis. The clinical presentation is changeful: Encefalitis, meningitis, radiculitis, myelitis, neuropathies, subarachnoid hemorrhage, psychiatric manifestations, brain abscess and demyelinating syndromes. Clinical abstract: a 70 years old male , with no degeneratives diseases, personal history of occasional alcoholism, with diagnostic and treatment of brucellosis since march of 2016, without complete scheme. He presented fluctuanting fever for 2 weeks before hospital admission, weight los, syncopes, slow march, inttermitent disorientation, diarrhea and cough. At physical exploration he presented awareness, orientation about space and person but not in time, short-them memory altered , weakness in half left body, muscular force 4/5, osteotendinous reflexes ++/+++. Magnetic resonance shows light enhancement of leptomenynges, subcortical/ cortical nodular lesions, peripheral edema at basal nucleus, talamo, brain stem and cerebellum; and ring enhancing. The antigen pink bengal test and standard agglutination with 2-mercapto,etanol in cerebroespinal fluid show positivity. This patient is in treatmente with specific antibiotics with clinical and radiological image improvement. Conclusion: neurobrucellosis have no typical clinical and radiological image presentation, the Brucella microorganism is isolated in CSF in just 20% of the cases. IRM is an imaging tool useful to show the parenchymal and craneal nerves lesions, meningeal involvement is seen after contrast administration; the most specific findings are: focal cortical brain lesions with ring enhancing and surrounding edema, vascular disturbance and generalized inflammation. Neuroimaging and neurophysiologic evaluation along with microbiological diagnosis are useful in early detection of complications and improve prognosis.