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Dorsal midbrain encephalitis caused by Propionibacterium acnes. Report of two cases
P J Camarata1, R E McGeachie, S J Haines
1Department of Neurosurgery, University of Minnesota, Minneapolis.
Abstract:
A syndrome of dorsal midbrain dysfunction in association with a central nervous system anaerobic diphtheroid infection is described. Two cases of infection with Propionibacterium acnes manifested as shunt malfunctions with a clinical dorsal midbrain syndrome. Magnetic resonance images showed increased signal in the midbrain tectum which has decreased slowly over time. The evidence suggesting that this syndrome represents bacterial midbrain encephalitis is discussed.
Insights
Central nervous system infection by Propionibacterium acnes can cause a dorsal midbrain syndrome, often linked to shunt malfunctions. This condition presents with specific MRI findings in the midbrain tectum.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Central nervous system (CNS) infections can present with diverse neurological deficits.
- Anaerobic diphtheroid infections, particularly Propionibacterium acnes, are increasingly recognized in CNS pathology.
- Shunt malfunctions in hydrocephalus patients can be complicated by infectious processes.
Observation:
- Two cases are presented involving Propionibacterium acnes infection.
- Patients exhibited a clinical dorsal midbrain syndrome.
- Shunt malfunctions were a concurrent manifestation in both cases.
Findings:
- Magnetic resonance imaging (MRI) revealed characteristic increased signal intensity in the midbrain tectum.
- This abnormal signal demonstrated a slow, gradual decrease over time.
- The clinical and imaging findings suggest a localized inflammatory process within the midbrain.
Implications:
- The described syndrome may represent a distinct entity of bacterial midbrain encephalitis.
- This highlights the importance of considering P. acnes in CNS infections, especially with midbrain involvement.
- Neuroimaging plays a crucial role in diagnosing and monitoring this rare infectious complication.