[Refractory epilepsy as the presenting symptom of a brucellar brain abscess].
BACKGROUND
Brucellosis is a zoonotic disease that is occasionally transmitted to human beings from infected animal reservoirs. It is an important condition in endemic areas. One infrequent complication of systemic brucellosis is the infection of the central or the peripheral nervous systems.


METHODS
A 54-year-old male who was being studied prior to surgery for refractory epilepsy, with clinical expression in the form of complex partial seizures. Neuroimaging findings revealed an expansive lesion in the right temporal lobe, which direct serological, histopathological and microbiological evidence showed to be a chronic brucellar abscess. After combined treatment involving complete surgical resection followed by a cycle of standard antimicrobial therapy, the patient was seizure-free at one year of follow-up.


CONCLUSIONS
Despite its low frequency, infection by Brucella must be considered in the differential diagnosis of intracranial expansive lesions, as well as in the case of patients whose presenting symptoms are epileptic seizures. To perform the diagnosis it is especially important to be aware of the wide range of clinical and radiological manifestations that can be produced, and which do not always correlate. Identification of risk factors on the patient record is also a crucial step.
Carrasco-Moro
R
R
Servicio de Neurocirugía, Hospital Universitario de la Princesa, 28006 Madrid, España. rocamo@gmail.com
García-Navarrete
E
E
Pedrosa-Sánchez
M
M
Pascual-Garvi
J M
JM
Minervini-Marín
M
M
Sola
R G
RG
D000382:Agricultural Workers' Diseases / Q000175:diagnosis; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001922:Brain Abscess / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D002006:Brucellosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D003399:Craniotomy; D004318:Doxycycline / Q000627:therapeutic use; D004351:Drug Resistance; D004569:Electroencephalography; D004830:Epilepsy, Tonic-Clonic / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012293:Rifampin / Q000627:therapeutic use; D013702:Temporal Lobe / Q000382:microbiology / Q000473:pathology; D014741:Video Recording
D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D004318:Doxycycline; D012293:Rifampin