Microbial DNA testing for inflammatory diseases of the brain of uncertain etiology

Abstract

SummaryNeurologists may be confronted with patients who present with inflammatory brain lesions where the diagnosis cannot be made through history and physical examination alone. Molecular testing for bacterial infections, tuberculosis, and fungal infections may aid in the diagnosis. Since the treatments for these disorders are different and delays can result in permanent neurologic disability and death, rapid and accurate diagnoses are critical. This review provides the neurologist with testing options and recommends ways to enhance sensitivity and specificity. W e present a patient with an inflammatory brain lesion with unclear etiology. Universal bacterial PCR testing on a biopsy specimen allowed us to make the diagnosis of neurosyphilis. Case reportA 27-year-old woman presented to a local hospital with complaints of headache for 3 weeks and an episode of right upper extremity weakness lasting about an hour. The outside facility obtained a brain MRI, which revealed large, diffuse, confluent, T2 hyperintense signals in the frontal lobes (figure 1). There was rim and nodular gadolinium enhancement with sparing of the gray matter. Given this unusual MRI scan, the patient was transferred to our facility.