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Neurobrucellosis: clinical and neuroimaging correlation
M Walid Al-Sous1, Saeed Bohlega, M Zuheir Al-Kawi
1Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia.
AJNR. American Journal of Neuroradiology
|March 24, 2004
Summary
Neurobrucellosis, a treatable nervous system infection, shows varied imaging findings. Neuroimaging may be normal despite clinical signs, or reveal inflammatory, immune, or vascular changes. All patients improved with treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Neurobrucellosis, a treatable infection affecting the nervous system, has poorly documented manifestations.
- Understanding nervous system involvement patterns is crucial for diagnosis and management.
Purpose of the Study:
- To investigate patterns of nervous system involvement in neurobrucellosis.
- To determine if neuroimaging abnormalities correlate with clinical manifestations.
Main Methods:
- Reviewed 23 MRI studies (17 brain, 6 spine) and 7 brain CT scans in 23 patients with confirmed Brucella infection.
- Patients had positive serum and cerebrospinal fluid (CSF) Brucella titers.
Main Results:
- Central nervous system (CNS) involvement occurred in 12, peripheral nervous system (PNS) in 4, combined in 2, and isolated hearing loss in 5 patients.
- Imaging findings varied: 5/7 CT and 10/23 MRI studies were normal. Abnormalities included meningeal enhancement, nerve root enhancement, granuloma, white matter changes, and spinal cord atrophy.
- All patients improved clinically after 3-12 months of multidrug antimicrobial therapy.
Conclusions:
- Clinical-radiologic correlation in neurobrucellosis is inconsistent.
- Imaging can show inflammatory, immune-mediated, or vascular insults, but may also be normal despite clinical symptoms.
- While enhancement on imaging resolved, white matter and ischemic changes persisted post-treatment.