The listeria rhombencephalitis is an uncommon and severe infection of the brainstem, usually occurring in healthy adults with a typical biphasic picture 1 . A prodrome of fever, headache, nausea and vomiting followed by abrupt neurological symptoms 2 . A stiff neck is present in half of the cases and positive culture in cerebrospinal fluid (CSF) in about 40% of the cases. Mortality is high and serious sequelae are common 2 . We report a case of a patient with involvement of the brainstem and a favorable outcome. CASEA 65-year-old man presented with pain in right jaw, nuchal pain and right facial palsy, following gastroenteritis. The neurological exam revealed a palsy of VI and VII right cranial nerves, right hemifacial hypoesthesia, strength grade 3, hyperreflexia, Babinski sign bilaterally, neck stiffness and axial ataxia. The CSF showed: 100 cells/mm 3 (95% lymphocytes); protein 63 mg/dL; glucose 95 mg/dL; negative cultures for bacteria, fungi and acidfast bacilli. Magnetic resonance imaging (MRI) showed bilateral and asymmetric lesions involving the brainstem with a striking enhancement along the right trigeminal nerve and ipsilateral spinal trigeminal nucleus (Figure).With the diagnostic suspicion of herpes zoster encephalitis, the patient was treated with acyclovir and was transferred to an intensive care unit due to respiratory failure 24 hours later.Blood cultures showed the presence of Listeria monocytogenes later. Acyclovir was interrupted and intravenous ampicillin plus dexamethasone were initiated. The infection improved but the patient remained with severe neurological sequelae. The second MRI showed multiple hemorrhagic foci in the cerebellar hemispheres, brainstem, basal ganglia nuclei and capsular region. Mild signal abnormalities remained in the brainstem and cerebellar peduncles.At four months he began walking and making sounds that were gradually replaced by full speech. DISCUSSIONListeria monocytogenes is a Gram-positive organism transmitted by consumption of contaminated food. The diagnosis can be delayed if no meningeal signs are presented in the beginning of the disease 4 as in our patient. Cultures of CSF and blood are positive in 41% and 61% of cases, respectively 3 . In our case only the blood culture was positive.The CSF typically reveals an increased leukocyte count, with predominance of polymorphonuclear cells, increased protein, and normal glucose levels 5 . Our patient presented only a predominance of lymphomononuclear cells, maybe due to precoceous CSF examination.MRI is important for the early detection of parenchymal lesions, therefore, being crucial for early diagnosis and follow-up

Introduction. Neurosyphilis is an uncommon manifestation of central nervous system (CNS) infection caused by Treponema pallidum. Cases. We report three cases of neurosyphilis. Case 1 presented with ocular involvement: right optic atrophy and left optic neuritis; case 2 had a meningovascular form, with ischemic stroke; and case 3, a meningeal form, presented with headaches as the main complaint. Discussion. The cases reported had distinguished forms of neurosyphilis. Serologic diagnosis depends on the presence of antibodies: Veneral Disease Research Laboratory (VDRL) -not specific -and/ or Fluorescent Treponemal Antibody Absorption (FTA-ABS) -specific. Conclusion. In the cases above cerebrospinal fluid FTA-ABS was a diagnostic clue for neurosyphilis even though unreactive serum VDRL was found.

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