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[Rhombencephalitis caused by Listeria: clinical-radiological correlation]
N Aymerich1, F Lacruz, J Gállego
1Servicio de Neurología, Hospital de Navarra, Pamplona.
Anales Del Sistema Sanitario De Navarra
|September 24, 2004
Summary
Rhombencephalitis, a rare brainstem infection, presents in two phases. Early recognition of symptoms and prompt MRI are crucial for effective antibiotic treatment and improved patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Rhombencephalitis is an infrequent yet serious brainstem infection.
- It primarily affects previously healthy individuals.
Observation:
- The case details a patient initially presenting with nonspecific symptoms like headache, nausea, and fever.
- This progressed to focal neurological deficits, including cranial nerve asymmetry, cerebellar signs, and sensory deficits.
- Complications included acute respiratory insufficiency and urinary retention.
Findings:
- Early magnetic resonance imaging (MRI) revealed characteristic hyperintense lesions in the brainstem (bulb and pons) on T2 sequences.
- Initial treatment with ampicillin and tobramycin was modified to vancomycin due to Listeria monocytogenes (serotype 4B) resistance to ampicillin.
- The patient survived but experienced residual oculomotor and micturition issues.
Implications:
- Emphasizes the critical role of early clinical recognition of rhombencephalitis signs.
- Highlights the importance of prompt MRI for diagnosis and guiding appropriate antibiotic therapy.
- Underscores the need for timely intervention to improve prognosis and minimize sequelae.