1
|
Al Aamri M, Mathew V, Iqbal S, Al Mukhaini S. From Pseudotumor Cerebri to Neurobrucellosis: A Journey With Several Lessons. Cureus 2024; 16:e57496. [PMID: 38707027 PMCID: PMC11066609 DOI: 10.7759/cureus.57496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
We present a case admitted for evaluation of suspected idiopathic intracranial hypertension (IIH) with an unusual but important departure from the expected algorithm. A 31-year-old lady came with a two-week duration of a mild headache and one-week duration of double vision with no previously documented fever or any comorbidities. Clinically, she had papilledema and bilateral abducens palsy with no signs of meningeal irritation. MRI brain radiology was consistent with IIH. Her CSF study showed pleocytosis with elevated protein levels and normal glucose. Serology was positive for Brucella melitensis at low titers but CSF culture grew Brucella melitensis, confirming the diagnosis of neurobrucellosis. Her headache and abducens palsy improved over the first two weeks, and the papilledema resolved over two months with antibiotics. This clinical mimic is important for physicians (including neurophysicians) and Infectious Disease specialists. The radiological mimic comes from chinked (small) ventricles, unlike most meningeal diseases which can present with papilledema and abducens palsy including tuberculosis, cryptococcosis, and leptomeningeal carcinomatosis. A CSF study is mandatory in the workup of IIH despite massive improvements in imaging.
Collapse
|
2
|
Patra S, Kalwaje Eshwara V, Pai AR, Varma M, Mukhopadhyay C. Evaluation of clinical, diagnostic features and therapeutic outcome of neurobrucellosis: a case series and review of literature. Int J Neurosci 2021; 132:1080-1090. [PMID: 33287603 DOI: 10.1080/00207454.2020.1860969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM In this study, we aimed to discuss the clinical features, laboratory findings, treatment and outcome of seven cases of neurobrucellosis from a tertiary care center and review the available global literature. MATERIALS AND METHODS The diagnosis of neurobrucellosis was established using the following criteria in our setting: (1) signs and symptoms of neurological infection with examination of cerebrospinal fluid (CSF) revealing signs of meningitis, (2) isolation of Brucella spp. from blood and/or CSF and/or antibody titer ≥1:160 in serum using standard agglutination test (SAT) and/or the presence of anti-Brucella antibodies in CSF and/or detection of Brucella spp.-specific DNA from CSF using PCR. A literature search was performed to review previous cases of neurobrucellosis published worldwide during the last 30 years. RESULTS The proportion of neurobrucellosis was 2.8% in our setting. Fever with headache and altered sensorium were the major presenting complaints. Brucella melitensis was isolated from blood culture in 6 patients. From the literature search, a total of 221 cases of neurobrucellosis were reviewed and analyzed. Meningitis (32.6%), loss of hearing (25.8%) and encephalitis (14.9%) were the most common clinical features. Involvement of cranial nerves, polyradiculopathy and paraplegia were the major complications found in patients with neurobrucellosis. CONCLUSIONS Neurobrucellosis should always be considered in the differential diagnosis of befitting neurological, rheumatological, and neuropsychiatric presentations in endemic regions for brucellosis. To prevent morbidity and mortality associated with neurobrucellosis, a multimodal diagnostic approach is essential for early and accurate diagnosis and effective treatment.
Collapse
Affiliation(s)
- Sudipta Patra
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aparna Ramakrishna Pai
- Department of Neurology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Center for Emerging and Tropical Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
3
|
Turkoglu SA, Halicioglu S, Sirmatel F, Yildiz M, Yildiz N, Yildiz S. Vasculitis and neurobrucellosis: Evaluation of nine cases using radiologic findings. Brain Behav 2018; 8:e00947. [PMID: 29670827 PMCID: PMC5893346 DOI: 10.1002/brb3.947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 01/26/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Brucellosis is an important multisystemic disease with many different clinical symptoms, and its early diagnosis and treatment are possible. Neurobrucellosis (NB) is a rare but serious finding of brucellosis. Brucella can be seen as meningitis and encephalopathy, and it can cause cranial nerve pathologies, vascular syndromes, myopathy, spinal diseases, and psychiatric disorders. In NB, vascular syndromes secondary to inflammation are rarely seen. Here, we present nine young patients with vascular and nonspecific neuropsychiatric findings who had NB as the etiology of stroke. METHODS Nine patients who were admitted to our Neurology Clinic between 2012 and 2017 for various reasons in whom brucellosis was found in the etiology were retrospectively studied. The patients' symptoms, physical examination, laboratory and radiographic findings, treatments, and treatment responses are discussed. RESULTS Of the nine patients who presented to our clinic in the 4-year period, five were female. The average age was 49 years. Five patients had small vessel vasculitis, three had great vessel vasculitis, and one had meningoencephalitis and pons abscess. Two patients had granuloma, and one had an aneurysm. CONCLUSIONS We aimed to present our cases due to the fact that this disease should be kept in mind in the differential diagnosis of patients with stroke and similar neuropsychiatric findings.
Collapse
Affiliation(s)
- Sule Aydin Turkoglu
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Siddika Halicioglu
- Department of Radiology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Fatma Sirmatel
- Department of Infectious Diseases Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Murside Yildiz
- Department of Intensive Care Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Nebil Yildiz
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| | - Serpil Yildiz
- Department of Neurology Abant Izzet Baysal University Medical Faculty Bolu Turkey
| |
Collapse
|
4
|
Zhang J, Chen Z, Xie L, Zhao C, Zhao H, Fu C, Chen G, Hao Z, Wang L, Li W. Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection. ACTA ACUST UNITED AC 2017; 50:e5712. [PMID: 28380194 PMCID: PMC5423737 DOI: 10.1590/1414-431x20165712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/20/2016] [Indexed: 01/14/2023]
Abstract
A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.
Collapse
Affiliation(s)
- J Zhang
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Z Chen
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - L Xie
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - C Zhao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - H Zhao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - C Fu
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - G Chen
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - Z Hao
- Department of Neurosurgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - L Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| | - W Li
- Department of Clinical Laboratory, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
| |
Collapse
|
5
|
Occupational Neurobrucellosis Mimicking a Brain Tumor: A Case Report and Review of the Literature. Case Rep Infect Dis 2017; 2017:1434051. [PMID: 28299214 PMCID: PMC5337328 DOI: 10.1155/2017/1434051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/26/2017] [Indexed: 12/01/2022] Open
Abstract
Brucellosis is a zoonotic bacterial infection which is transmitted to humans from infected animals and is endemic in many parts of the world including Saudi Arabia. In this article, we report a case of occupational neurobrucellosis that presented with a space-occupying lesion mimicking a brain tumor. We stress on the importance of obtaining detailed social history including occupation to reach the diagnosis in several conditions including brucellosis. We also stress on taking universal precautions when handling any specimens. It may be advisable that manipulation of all unknown specimens arriving at the laboratory should occur in biological safety cabinet until a highly infectious organism is ruled out. Neurobrucellosis should be included in the differential diagnosis in patients presenting with solitary mass lesion mimicking brain tumor especially in endemic areas or high occupational risk group.
Collapse
|
6
|
Oueslati I, Berriche A, Ammari L, Abdelmalek R, Kanoun F, Kilani B, Tiouiri Benaissa H. Epidemiological and clinical characteristics of neurobrucellosis case patients in Tunisia. Med Mal Infect 2016; 46:123-30. [PMID: 26897309 DOI: 10.1016/j.medmal.2016.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to identify epidemiological, clinical, therapeutic, diagnostic, and outcome characteristics of neurobrucellosis case patients in Tunisia. PATIENTS AND METHODS We conducted a retrospective and descriptive study over a 17-year period (January 1997-December 2013). We included all neurobrucellosis patients hospitalized in the infectious disease department of La Rabta Hospital of Tunis during the study period. RESULTS A total of 13 patients were included in the study: 9 men and 4 women. Mean age was 31.6 years. Six patients presented with meningitis, three with encephalitis, two with meningoencephalitis, and two with meningo-myeloradiculitis. All patients had a lumbar puncture performed. Eleven patients had an abnormal cerebrospinal fluid (CSF) (84.6%): lymphocytic pleocytosis in seven patients, high level of CSF proteins in 11, and low level of CSF glucose in seven. All patients had a positive Brucella serological test in blood. A Brucella serological test was also performed in CSF and was positive for 10 patients (77%). A total of nine patients had a cerebral CT scan and/or MRI performed and abnormalities were observed in six patients. Antibiotic therapy was prescribed to all patients: a combination of rifampicin and co-trimoxazole (n=9) or doxycycline (n=4) for an average duration of eight months. Two patients also received steroids. A positive outcome was observed in 10 patients. Three patients were lost to follow up. CONCLUSION Brucellosis may be severe when neurological involvement occurs. Brucellosis should be considered in the event of any neurological involvement associated with suggestive epidemiological features.
Collapse
Affiliation(s)
- I Oueslati
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - A Berriche
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie.
| | - L Ammari
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - R Abdelmalek
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - F Kanoun
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - B Kilani
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| | - H Tiouiri Benaissa
- Service des maladies infectieuses, hôpital la Rabta, Tunis, Tunisie; Université Tunis El Manar - faculté de médecine de Tunis, Tunis, Tunisie
| |
Collapse
|
7
|
Budnik I, Fuchs I, Shelef I, Krymko H, Greenberg D. Unusual presentations of pediatric neurobrucellosis. Am J Trop Med Hyg 2012; 86:258-60. [PMID: 22302859 DOI: 10.4269/ajtmh.2012.11-0468] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neurobrucellosis is an uncommon complication of pediatric brucellosis. Acute meningitis and encephalitis are the most common clinical manifestations, however symptoms may be protean and diagnosis requires a high index of suspicion in patients from endemic areas. Diagnosis is often based on neurological symptoms, serology, and suggestive brain imaging because cerebrospinal fluid culture yields are low. Two cases of pediatric neurobrucellosis with unusual clinical and radiologic findings are presented.
Collapse
Affiliation(s)
- Isolda Budnik
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | | | | | |
Collapse
|
8
|
Unusual presentation of neurobrucellosis: a solitary intracranial mass lesion mimicking a cerebral tumor : a case of encephalitis caused by Brucella melitensis. J Infect Chemother 2012; 18:767-70. [PMID: 22231602 PMCID: PMC3491191 DOI: 10.1007/s10156-011-0365-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 12/25/2011] [Indexed: 10/26/2022]
Abstract
Among the diverse presentations of neurobrucellosis, solitary intracranial mass lesions are extremely rare. To the best of our knowledge, we describe here the second case of neurobrucellosis mimicking a cerebral tumor caused by Brucella melitensis. The mass lesion was clinically and radiologically indistinguishable from a brain tumor. The diagnosis was established by isolating Brucella melitensis in a blood culture and a positive Wright's agglutination test on the cerebrospinal fluid at 1:320 titers. Paraffin sections of the cerebral mass showed nongranulomatous encephalitis. We suggest that patients with an isolated intraparenchymal mass lesion with nongranulomatous encephalitis should also be studied for brucellosis in endemic areas.
Collapse
|
9
|
Inan AS, Ceran N, Erdem I, Engin DO, Senbayrak S, Ozyurek SC, Goktas P. Neurobrucellosis with transient ischemic attack, vasculopathic changes, intracerebral granulomas and basal ganglia infarction: a case report. J Med Case Rep 2010; 4:340. [PMID: 20973948 PMCID: PMC2984467 DOI: 10.1186/1752-1947-4-340] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 10/25/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction Central nervous system involvement is a rare but serious manifestation of brucellosis. We present an unusual case of neurobrucellosis with transient ischemic attack, intracerebral vasculopathy granulomas, seizures, and paralysis of sixth and seventh cranial nerves. Case presentation A 17-year-old Caucasian man presented with nausea and vomiting, headache, double vision and he gave a history of weakness in the left arm, speech disturbance and imbalance. Physical examination revealed fever, doubtful neck stiffness and left abducens nerve paralysis. An analysis of his cerebrospinal fluid showed a pleocytosis (lymphocytes, 90%), high protein and low glucose levels. He developed generalized tonic-clonic seizures, facial paralysis and left hemiparesis. Cranial magnetic resonance imaging demonstrated intracerebral vasculitis, basal ganglia infarction and granulomas, mimicking the central nervous system involvement of tuberculosis. On the 31st day of his admission, neurobrucellosis was diagnosed with immunoglobulin M and immunoglobulin G positivity by standard tube agglutination test and enzyme-linked immunosorbent assay in both serum and cerebrospinal fluid samples (the tests had been negative until that day). He was treated successfully with trimethoprim and sulfamethoxazole, doxycyline and rifampicin for six months. Conclusions Our patient illustrates the importance of suspecting brucellosis as a cause of meningoencephalitis, even if cultures and serological tests are negative at the beginning of the disease. As a result, in patients who have a history of residence or travel to endemic areas, neurobrucellosis should be considered in the differential diagnosis of any neurologic symptoms. If initial tests fail, repetition of these tests at appropriate intervals along with complementary investigations are indicated.
Collapse
Affiliation(s)
- Asuman Sengoz Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Tıbbiye Street, 34668, Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
10
|
Castells X, García-Gómez JM, Navarro A, Acebes JJ, Godino O, Boluda S, Barceló A, Robles M, Ariño J, Arús C. Automated brain tumor biopsy prediction using single-labeling cDNA microarrays-based gene expression profiling. ACTA ACUST UNITED AC 2010; 18:206-18. [PMID: 19861896 DOI: 10.1097/pdm.0b013e31818f071b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Gene signatures obtained from microarray experiments may be of use to improve the prediction of brain tumor diagnosis. Nevertheless, automated and objective prediction with accuracy comparable to or better than the gold standard should be convincingly demonstrated for possible clinician uptake of the new methodology. Herewith, we demonstrate that primary brain tumor types can be discriminated using microarray data in an automated and objective way. METHODS Postsurgical biopsies from 35 patients [17 glioblastoma multiforme (Gbm) and 18 meningothelial meningioma (Mm)] were stored in liquid nitrogen, total RNA was extracted, and cDNA was labeled with Cy3 fluorochrome and hybridized onto a cDNA-based microarray containing 11,500 cDNA clones representing 9300 loci. Scanned data were preprocessed, normalized, and used for predictor development. The predictive functions were fitted to a subset of samples and their performance evaluated with an independent subset. Expression results were validated by means of real time-polymerase chain reaction. RESULTS Some gene expression-based predictors achieved 100% accuracy both in training resampling validation and independent testing. One of them, composed of GFAP, PTPRZ1, GPM6B and PRELP, produced a 100% prediction accuracy for both training and independent test datasets. Furthermore, the gene signatures obtained, increased cell detoxification, motility and intracellular transport in Gbm, and increased cell adhesion and cytochrome-family genes in Mm, agree well with the expected biologic and pathologic characteristics of the studied tumors. CONCLUSIONS The ability of gene signatures to automate prediction of brain tumors through a fully objective approach has been demonstrated. A comparison of gene expression profiles between Gbm and Mm may provide additional clues about patterns associated with each tumor type.
Collapse
Affiliation(s)
- Xavier Castells
- Grup d'aplicacions Biomèdiques de la RMN, Departament de Bioquímica i Biologia Molecular, Facultat de Biociències, Universitat Autònoma de Barcelona, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Neurobrucellosis: a partially treatable cause of vision loss. Pediatr Neurol 2009; 40:401-3. [PMID: 19380082 DOI: 10.1016/j.pediatrneurol.2008.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 12/01/2008] [Accepted: 12/04/2008] [Indexed: 10/20/2022]
Abstract
Involvement of the central nervous system due to brucellosis is rare and has a broad range of clinical manifestations. Reported here is a case of neurobrucellosis in a 13-year-old boy leading to visual impairment and unilateral hearing loss. Cranial magnetic resonance imaging revealed a suprasellar mass with extension to the optic chiasm. This case represents a novel finding of pediatric neurobrucellosis involving the optic chiasm. The patient's visual acuity, but not hearing, improved after initiation of antibiotic therapy.
Collapse
|
12
|
First case report of neurobrucellosis associated with hydrocephalus. Clin Neurol Neurosurg 2008; 110:739-42. [DOI: 10.1016/j.clineuro.2008.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 03/20/2008] [Accepted: 04/05/2008] [Indexed: 11/16/2022]
|
13
|
Neurobrucellosi. Neurologia 2008. [DOI: 10.1016/s1634-7072(08)70539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|