• 1.

    Bahemuka M, Shemena AR, Panayiotopoulos CP, al-Aska AK, Obeid T, Daif AK, 1988. Neurological syndromes of brucellosis. J Neurol Neurosurg Psychiatry 51: 10171021.

    • Search Google Scholar
    • Export Citation
  • 2.

    Kochar DK, Agarwal N, Jain N, Sharma BV, Rastogi A, Meena CB, 2000. Clinical profile of neurobrucellosis—a report on 12 cases from Bikaner (north-west India). J Assoc Physicians India 48: 376380.

    • Search Google Scholar
    • Export Citation
  • 3.

    Shakir RA, 1986. Neurobrucellosis. Postgrad Med J 62: 10771079.

  • 4.

    Ceviker N, Baykaner K, Goksel M, Sener L, Alp H, 1989. Spinal cord compression due to Brucella granuloma. Infection 17: 304305.

  • 5.

    Nas K, Gür A, Kemaloglu M, Geyik MF, Cevik R, Büke Y, Ceviz A, Saraç AJ, Aksu Y, 2001. Management of spinal brucellosis and outcome of rehabilitation. Spinal Cord 39: 223.

    • Search Google Scholar
    • Export Citation
  • 6.

    Goktepe AS, Alaca R, Mohur H, Coskun U, 2003. Neurobrucellosis and a demonstration of its involvement in spinal roots via magnetic resonance imaging. Spinal Cord 41: 574576.

    • Search Google Scholar
    • Export Citation
  • 7.

    Miller JR, Jubelt B, 2000. Bacterial infections. Rowland LP, ed. Merritt’s Neurology, 10th edition. Philadelphia, PA: Lippincott, Williams & Wilkins, 103107.

  • 8.

    Gul HC, Erdem H, Gorenek L, Ozdag MF, Kalpakci Y, Avci IY, Besirbellioglu BA, Eyigun CP, 2008. Management of neurobrucellosis: an assessment of 11 cases. Intern Med 47: 9951001.

    • Search Google Scholar
    • Export Citation
  • 9.

    Bodur H, Erbay A, Akinci E, Colpan A, Cevik MA, Balaban N, 2003. Neurobrucellosis in an endemic area of brucellosis. Scand J Infect Dis 35: 9497.

  • 10.

    Yetkin MA, Bulut C, Erdinc FS, Oral B, Tulek N, 2006. Evaluation of the clinical presentations in neurobrucellosis. Int J Infect Dis 10: 446452.

  • 11.

    Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA, 1987. Clinical categories of neurobrucellosis. A report on 19 cases. Brain 110: 213223.

  • 12.

    McLean DR, Russell N, Khan MY, 1992. Neurobrucellosis: clinical and therapeutic features. Clin Infect Dis 15: 582590.

  • 13.

    Valenza G, Kallmann B, Berend A, Mlynski R, Nöckler K, Kurzai O, Frosch M, Abele-Horn M, 2006. Isolation of Brucella melitensis from a patient with hearing loss. Eur J Clin Microbiol Infect Dis 25: 6768.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ceran N, Turkoglu R, Erdem I, Inan A, Engin D, Tireli H, Goktas P, 2011. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region. Braz J Infect Dis 15: 5259.

    • Search Google Scholar
    • Export Citation
  • 15.

    Alton G, Jones L, Angus R, Verger J, 1988. Techniques for the Brucellosis Laboratory. Paris, France: Institut National de la Recherche Agronomique.

  • 16.

    Baldi P, Araj G, Racaro G, Wallach J, Fossati C, 1999. Detection of antibodies to Brucella cytoplasmic proteins with neurobrucellosis. Clin Diagn Lab Immunol 5: 756759.

    • Search Google Scholar
    • Export Citation

 

 

 

 

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

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  • 1 Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India;
  • 2 Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India;
  • 3 Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India;
  • 4 Department of Neuroimaging and Interventional Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India

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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