Infection

, Volume 44, Issue 5, pp 623–631 | Cite as

Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study

  • Hakan Erdem
  • Seniha Senbayrak
  • Kaan Meriç
  • Ayşe Batirel
  • Mustafa Kasım Karahocagil
  • Rodrigo Hasbun
  • Gonul Sengoz
  • Hasan Karsen
  • Selçuk Kaya
  • Ayşe Seza Inal
  • Abdullah Umut Pekok
  • Mustafa Kemal Celen
  • Secil Deniz
  • Mehmet Ulug
  • Tuna Demirdal
  • Mustafa Namiduru
  • Recep Tekin
  • Tumer Guven
  • Emine Parlak
  • Sibel Bolukcu
  • Meltem Avci
  • Oguz Reşat Sipahi
  • Derya Ozturk-Engin
  • Kadriye Yaşar
  • Filiz Pehlivanoglu
  • Emel Yilmaz
  • Selma Ates-Guler
  • Esmeray Mutlu-Yilmaz
  • Selma Tosun
  • Fatma Sirmatel
  • Elif Sahin-Horasan
  • Ayhan Akbulut
  • Nefise Oztoprak
  • Yasemin Cag
  • Ayten Kadanali
  • Huseyin Turgut
  • Ali Irfan Baran
  • Hanefi Cem Gul
  • Mahmut Sunnetcioglu
  • Asli Haykir-Solay
  • Affan Denk
  • Asuman Inan
  • Celal Ayaz
  • Asim Ulcay
  • Sukran Kose
  • Canan Agalar
  • Nazif Elaldi
Original Paper

Abstract

Objective

Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes.

Methods

Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain.

Results

A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1–28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002–1.013, p = 0.044), cerebrospinal fluid (CSF)/serum glucose rate (OR 0.001; 95 % CI 000–0.067, p = 0.001), and CSF protein (OR 2.5; 95 % CI 2.3–2.7, p = 0.0001) were associated with diffuse inflammation.

Conclusions

In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.

Keywords

Neurobrucellosis Computerized tomography Magnetic resonance imaging Diagnosis Inflammation 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author (Hakan Erdem) states that there is no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Hakan Erdem
    • 1
  • Seniha Senbayrak
    • 2
  • Kaan Meriç
    • 3
  • Ayşe Batirel
    • 4
  • Mustafa Kasım Karahocagil
    • 5
  • Rodrigo Hasbun
    • 6
  • Gonul Sengoz
    • 7
  • Hasan Karsen
    • 8
  • Selçuk Kaya
    • 9
  • Ayşe Seza Inal
    • 10
  • Abdullah Umut Pekok
    • 11
  • Mustafa Kemal Celen
    • 12
  • Secil Deniz
    • 2
  • Mehmet Ulug
    • 13
  • Tuna Demirdal
    • 14
  • Mustafa Namiduru
    • 15
  • Recep Tekin
    • 12
  • Tumer Guven
    • 16
  • Emine Parlak
    • 17
  • Sibel Bolukcu
    • 18
  • Meltem Avci
    • 19
  • Oguz Reşat Sipahi
    • 18
  • Derya Ozturk-Engin
    • 2
  • Kadriye Yaşar
    • 20
  • Filiz Pehlivanoglu
    • 7
  • Emel Yilmaz
    • 21
  • Selma Ates-Guler
    • 22
  • Esmeray Mutlu-Yilmaz
    • 23
  • Selma Tosun
    • 19
  • Fatma Sirmatel
    • 24
  • Elif Sahin-Horasan
    • 25
  • Ayhan Akbulut
    • 26
  • Nefise Oztoprak
    • 27
  • Yasemin Cag
    • 28
  • Ayten Kadanali
    • 29
  • Huseyin Turgut
    • 30
  • Ali Irfan Baran
    • 5
  • Hanefi Cem Gul
    • 31
  • Mahmut Sunnetcioglu
    • 5
  • Asli Haykir-Solay
    • 32
  • Affan Denk
    • 26
  • Asuman Inan
    • 2
  • Celal Ayaz
    • 12
  • Asim Ulcay
    • 31
  • Sukran Kose
    • 33
  • Canan Agalar
    • 34
  • Nazif Elaldi
    • 35
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyGulhane Medical AcademyAnkaraTurkey
  2. 2.Department of Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  3. 3.Department of RadiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  4. 4.Department of Infectious Diseases and Clinical MicrobiologyDr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  5. 5.Department of Infectious Diseases and Clinical MicrobiologyYuzuncuyil University School of MedicineVanTurkey
  6. 6.Department of Infectious Diseases, Medical SchoolThe University of Texas Health Science Center at HoustonHoustonUSA
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyHaseki Training and Research HospitalIstanbulTurkey
  8. 8.Department of Infectious Diseases and Clinical MicrobiologyHarran University, School of MedicineSanliurfaTurkey
  9. 9.Department of Infectious Diseases and Clinical MicrobiologyKaradeniz Technical University School of MedicineTrabzonTurkey
  10. 10.Department of Infectious Diseases and Clinical MicrobiologyCukurova University School of MedicineAdanaTurkey
  11. 11.Department of Infectious Diseases and Clinical MicrobiologyPrivate Erzurum Sifa HospitalErzurumTurkey
  12. 12.Department of Infectious Diseases and Clinical MicrobiologyDicle University School of MedicineDiyarbakirTurkey
  13. 13.Department of Infectious Diseases and Clinical MicrobiologyPrivate Umit HospitalEskisehirTurkey
  14. 14.Department of Infectious Diseases and Clinical MicrobiologyKatip Celebi University School of MedicineIzmirTurkey
  15. 15.Department of Infectious Diseases and Clinical MicrobiologyGaziantep University School of MedicineGaziantepTurkey
  16. 16.Department of Infectious Diseases and Clinical MicrobiologyAnkara Atatürk Training & Research HospitalAnkaraTurkey
  17. 17.Department of Infectious Diseases and Clinical MicrobiologyAtaturk University School of MedicineErzurumTurkey
  18. 18.Department of Infectious Diseases and Clinical MicrobiologyBezmi Alem Vakif University School of MedicineIstanbulTurkey
  19. 19.Department of Infectious Diseases and Clinical MicrobiologyIzmir Bozyaka Training and Research HospitalIzmirTurkey
  20. 20.Department of Infectious Diseases and Clinical MicrobiologyBakırkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
  21. 21.Department of Infectious Diseases and Clinical MicrobiologyUludag University School of MedicineBursaTurkey
  22. 22.Department of Infectious Diseases and Clinical MicrobiologySutcu Imam University School of MedicineKahramanmarasTurkey
  23. 23.Department of Infectious Diseases and Clinical MicrobiologySamsun Training and Research HospitalSamsunTurkey
  24. 24.Department of Infectious Diseases and Clinical MicrobiologyIzzet Baysal University School of MedicineBoluTurkey
  25. 25.Department of Infectious Diseases and Clinical MicrobiologyMersin University School of MedicineMersinTurkey
  26. 26.Department of Infectious Diseases and Clinical MicrobiologyFirat University School of MedicineElazigTurkey
  27. 27.Department of Infectious Diseases and Clinical MicrobiologyAntalya Training and Research HospitalAntalyaTurkey
  28. 28.Department of Infectious Diseases and Clinical MicrobiologyMedeniyet University, Goztepe Training ad Research HospitalIstanbulTurkey
  29. 29.Department of Infectious Diseases and Clinical MicrobiologyUmraniye Training and Research HospitalIstanbulTurkey
  30. 30.Department of Infectious Diseases and Clinical MicrobiologyPamukkale University School of MedicineDenizliTurkey
  31. 31.Department of Infectious Diseases and Clinical MicrobiologyGATA Haydarpasa Training HospitalIstanbulTurkey
  32. 32.Department of Infectious Diseases and Clinical MicrobiologyIgdir State HospitalIgdirTurkey
  33. 33.Department of Infectious Diseases and Clinical MicrobiologyTepecik Training and Research HospitalIzmirTurkey
  34. 34.Department of Infectious Diseases and Clinical MicrobiologyFatih Sultan Mehmet Training and Research HospitalIstanbulTurkey
  35. 35.Department of Infectious Diseases and Clinical MicrobiologyCumhuriyet University School of MedicineSivasTurkey

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