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

Nashi, Saraswati; Preethish‐Kumar, Veeramani; Maji, Sayani; Chandrashekar, N.; Polavarapu, Kiran; Kashinkunti, Chetan; Bhattacharya, Kajari; Saini, Jitender; Nalini, Atchayaram

doi:10.4269/ajtmh.17-0828

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…So, for suspected patients, serology testing and CSF analysis are preferred. A serology test using agglutination tests from CSF is recorded as being nonsensitive in chronic infection 11 , 12 .…”

Section: Discussionmentioning

confidence: 99%

A case series of pediatric neurobrucellosis: a rare complication to a common disease

Mohammed

Ezzatly

Siddiq

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Neurobrucellosis (NB) is a rare complication of the most common zoonotic infection worldwide. Meningitis and encephalitis are the most common manifestations. While it is endemic in many countries, it is frequently misdiagnosed due to its nonspecific presentations, and it requires a high index of suspicion and special care to be cured. Case presentation: The first case is from a rural area and presented with a prolonged fever associated with profuse sweating, which was complicated later by headache and sudden left-sided weakness associated with urine incontinence without signs of meningeal irritation. Laboratory and radiological tests confirmed the diagnosis of NB after other cerebral infections were ruled out, and the patient received the full brucella regimen and recovered well. The second patient presented with a gradual onset of fever that did not respond to conventional treatment. Days later, his condition was complicated by a convulsion that was not preceded by an aura and was not accompanied by symptoms of weakness, increased intracranial pressure, or sphincteric disturbances. He has a history of drinking raw milk, and tests for brucella were positive, ruling out other intracranial infections and masses. He received full brucella treatment and showed good recovery. Conclusion: A patient from an endemic area who has a prolonged fever and neurological symptoms should be considered positive for NB until it is ruled out.

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Section: Discussionmentioning

confidence: 99%

A case series of pediatric neurobrucellosis: a rare complication to a common disease

Mohammed

Ezzatly

Siddiq

et al. 2023

Annals of Medicine &Amp; Surgery

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The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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

Cited by 2 publications

References 15 publications

A case series of pediatric neurobrucellosis: a rare complication to a common disease

A case series of pediatric neurobrucellosis: a rare complication to a common disease

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

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