Brainstem encephalitis (rhombencephalitis) due to Listeria monocytogenes: case report and review.
Listerial brainstem encephalitis is a rare disease. Only 62 cases have been reported previously; all were in adults, only 8% of whom were immunosuppressed. The disease has a characteristic biphasic course: a nonspecific prodrome of headache, nausea or vomiting, and fever lasting for several days is followed by progressive asymmetrical cranial-nerve palsies, cerebellar signs, hemiparesis or hypesthesia, and impairment of consciousness. Neck stiffness was initially present in only 55% of the cases described thus far. Studies of cerebrospinal fluid often revealed only mild abnormalities. Cultures of cerebrospinal fluid and blood were positive in 41% and 61% of cases, respectively. Respiratory failure occurred in 41% of cases. Initial computed tomography of the brain often gave normal results; magnetic resonance imaging better demonstrated brainstem abnormalities. Overall mortality was 51%. All untreated patients died. When treatment with ampicillin or penicillin was initiated early, the rate of survival was > 70%; however, neurological sequelae developed in 61% of survivors.
Department of Medicine, Good Samaritan Hospital of Santa Clara Valley, San Jose, California.
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Armstrong
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Fung
D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000382:microbiology*; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008088:Listeriosis / Q000134:cerebrospinal fluid / Q000382:microbiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000150:complications