Neurobrucellosis with ischemic stroke and spinal cord involvement: a case report

Abstract

Background: Brucellosis is a common zoonotic disease that may have a variety of clinical manifestations when it affects the nervous system. Ischemic stroke is a rare clinical symptom, but if it is not diagnosed and treated early, it may cause more severe consequences.

Case presentation: We report a 38-year-old man presenting with hearing impairment for four years and sudden weakness of the right limb for two years, recurrent aphasia, and gradual weakness of bilateral lower limbs for nine months. He had bilateral positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed ischemic infarcts in the pons and extensive enhancement of spinal meninges combined with spinal cord atrophy and ischemia. The tests revealed Brucella Rose Bengal positive in serum and CSF. Brucella culture in CSF was also positive. Next-generation sequencing (NGS) of CSF revealed positive for Brucella with 105 species were detected. He showed significant improvement with antibiotics at five months follow-up.

Conclusions: Neurobrucellosis may mimic stroke and transverse myelitis like syndromes. NB is a treatable infectious condition and should always be considered in the differentials, especially if there are risk factors, as in our case.

Keywords: Cerebrospinal fluid; Neurobrucellosis; Spinal cord; Stroke.

Fig. 1

Diffusion weighted imaging (a) and T2-weighted image (b) showed pons infarction (arrow)

Fig. 2

In postcontrast coronal (a) and sagittal series (b), diffuse leptomeningeal enhancement (arrow) of the cervical spinal cord were observed

Fig. 3

T2-weighted images view compression fracture of T7 vertebrae (arrow) in dorsal spine-sagittal (a), atrophy of thoracic spinal cord (b), and “Snake eyes sign” (means ischemia) of the cervical spinal cord (c) in the axis

Fig. 4

Gram-stained Brucella colonies of cerebrospinal fluid culture under an optical microscope

Fig. 5

Enhancement of cervical MR at ten-month follow-up showed that the leptomeningeal enhancement was significantly improved compared with the previous one. There was no obvious enhancement in the coronal view (a), and slightly enhancement was seen in the sagittal view (b)