Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study
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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.
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.
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.
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.
KeywordsNeurobrucellosis Computerized tomography Magnetic resonance imaging Diagnosis Inflammation
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Conflict of interest
On behalf of all authors, the corresponding author (Hakan Erdem) states that there is no conflict of interest.
- 1.Gul HC, Erdem H. Brucellosis (brucella species). In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, douglass, and bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier Co; 2015. p. 2584–9.Google Scholar
- 22.Tunkel AR. Approach to the patient with central nervous system infection. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglass, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier Co; 2015. p. 1091–6.Google Scholar
- 24.Shakir RA. Brucellosis. In: Shakir RA, Neuman PK, Poser CM, editors. Tropical neurology. Cambridge: WB Saunders; 1996. p. 168–79.Google Scholar
- 32.Al-Kawi MZ. Brucellosis. In: Moher JP, Gautier J, editors. Guide to clinical neurology. New York: Churchill Livingstone Co; 1995. p. 677–80.Google Scholar