Case Report: Neurobrucellosis with Plastered Spinal Arachnoiditis: A Magnetic Resonance Imaging–Based Report

Saraswati Nashi Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Veeramani Preethish-Kumar Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Sayani Maji Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Nagarathna Chandrashekar Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Kiran Polavarapu Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Chetan Kashinkunti Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Kajari Bhattacharya Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India

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Jitender Saini Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India

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Atchayaram Nalini Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;

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Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, dysphagia, dysarthria, hypophonia for 6 months, and gait unsteadiness for 5 months. He had bilateral 5th (motor) to 12th cranial nerve palsy, wasting and weakness of limbs, fasciculations, absent tendon reflexes, and positive Babinski’s sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed extensive enhancing exudates in cisterns and post-contrast enhancement of bilateral 5th, 6th, 7th, and 8th nerves. Spine showed clumping with contrast enhancement of the cauda equina roots and encasement of the cord with exudates. Serum and CSF were positive for anti-Brucella antibodies. He showed significant improvement with antibiotics. At 4 months follow-up, MRI demonstrated near complete resolution of cranial and spinal arachnoiditis. It is important to recognize such rare atypical presentations of neurobrucellosis.

Author Notes

Address correspondence to Atchayaram Nalini, Department of Neurology, Neuroscience Faculty Block, National Institute of Mental Health and Neurosciences, Bangalore 560029, India. E-mail: atchayaramnalini@yahoo.co.in

Authors’ addresses: Saraswati Nashi, Chetan Kashinkunti, and Atchayaram Nalini, Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India, E-mails: nandanashi@gmail.com, chetankashinkunti@rocketmail.com, and atchayaramnalini@yahoo.co.in. Veeramani Preethish-Kumar and Kiran Polavarapu, Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, India, and Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India, E-mails: prthshkumar@gmail.com and kinnudreamz@gmail.com. Sayani Maji and Nagarathna Chandrashekar, Department of Neuromicrobiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India, E-mails: maji.sayani@gmail.com and nagarathnachandrashekar@gmail.com. Kajari Bhattacharya and Jitender Saini, Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India, E-mails: kajaribhattacharya7@gmail.com and jsaini76@gmail.com.

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