Neurobrucellosis: clinical and neuroimaging correlation.
OBJECTIVE
Manifestation of nervous system involvement by neurobrucellosis, a treatable infection, is not well documented. We investigated patterns of nervous system involvement and determined if neuroimaging abnormalities correlated with clinical manifestations of neurobrucellosis.


METHODS
We reviewed 23 MR imaging studies (17 of brain, six of spine) and seven CT scans of brain in 23 patients (14 male and nine female patients; age range 17-71 years) with positive Brucella titers in their serum and CSF.


RESULTS
Twelve patients had central nervous system (CNS) involvement, four had peripheral nervous system (PNS) involvement, two had combined PNS and CNS involvement, and five had isolated hearing loss. Imaging findings were variable: five of seven brain CT studies were normal, and 10 of 23 MR studies were normal (eight brain, one thoracic, one lumbar). One brain CT study showed subthalamic hemorrhage, mild perivascular enhancement, left caudate lacunae, and diffuse white matter changes. One other brain CT study showed enhancement of the tentorium in addition to white matter changes. Abnormal MR findings were basal meningeal enhancement (n = 3), lumbar nerve root enhancement (n = 3), granuloma of the suprasellar region (n = 1), diffuse white matter changes (n = 7), and spinal cord atrophy (n = 1). All patients improved after treatment with three antimicrobial drugs for 3-12 months. Seven patients had follow-up imaging; the enhancement disappeared but the white matter and ischemic changes persisted despite almost complete clinical recovery.


CONCLUSIONS
Clinical-radiologic correlation in neurobrucellosis varies from a normal imaging study despite positive clinical findings, to a variety of imaging abnormalities that reflect either an inflammatory process, an immune-mediated process, or a vascular insult.
Al-Sous
M Walid
MW
Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia.
Bohlega
Saeed
S
Al-Kawi
M Zuheir
MZ
Alwatban
Jehad
J
McLean
Donald R
DR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D002006:Brucellosis / Q000175:diagnosis*; D003711:Demyelinating Diseases / Q000175:diagnosis; D003937:Diagnosis, Differential; D004679:Encephalomyelitis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009460:Neurologic Examination; D013116:Spinal Cord / Q000473:pathology; D014057:Tomography, X-Ray Computed