Neurobrucellosis as an exceptional cause of transient ischemic attacks

Abstract

We report a series of four cases presented with transient ischemic attacks (TIA) or ischemic stroke as the predominant manifestation of neurobrucellosis (NB). Three of the patients were 20–28 years of age, and one patient was 53 years old. They all used to consume unpasteurized milk or its products. Two patients had systemic brucellosis in the past and received antibiotic treatment. Other causes of TIA including cardiac embolism, hypercoagulability, vascular malformations, systemic vasculitis, and infective endocarditis were excluded. NB was diagnosed with serological tests or cultures for Brucella in the cerebrospinal fluid. None of the patients had any further TIA after the initiation of specific treatment. NB should always be sought in young patients with TIA or ischemic stroke, especially if they have no risk factors for stroke and live in an endemic area for brucellosis, even if they do not have other systemic signs of brucellosis.

An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings

“…Several clinical forms of brucellosis affecting the CNS have been reported, including meningitis, meningoencephalitis, myelitis, radiculoneuritis, cranial nerve involvement, and demyelinating or vascular disease (3,4,6,7). Thus, the presentation of NB is diverse (6).…”

Neurobrucellosis

“…The third patient presented as meningitis which is the most clinical presentation of neurobrucellosis and meningovascular complications (8)(9)(10)13). His cranial MRI showed that meningeal enhancement with periventricular edema which seen on brain imaging in the early phase of brucellar meningitis.…”

“…Neurobrucellosis is a rare complication of brucellosis and sometimes neurological symptoms may be the only symptoms. The criteria for definite diagnosis of neurobrucellosis are 1-neurological dysfunction not explained by other neurological diseases, 2-abnormal CSF indicating lymphocytic pleocytosis and increased protein, 3-positive CSF culture for Brucella organisms or positive Brucella IgG agglutination titer in the blood and 4-CSF, response to specific chemotherapy with a significant drop in the CSF lymphocyte count and protein concentration (4,5,8). We presented three different clinic forms of neurobrucellosis which fulfilled all the diagnostic criteria.…”

“…e n c e p h a l o p a t h y / m e n i n g o e n c e p h a l i t i s , inflammatory peripheral neuritis/radiculitis, inflammatory demyelinative syndromes, papilledema or papillitis without other focal features, meningomyelitis, posterior fossa (ataxic or brainstem) syndromes, and neuropsychiatric syndromes (3)(4)(5)(6)(7)(8)(9)(10).…”

A case of brucellosis displaying Parkinsonian-like tremor

“…Brucellosis is clinically characterized by fever, joint pain, night sweats, weight loss and hepatosplenomegaly. It is generally believed that only 4% of the patients have neurological manifestations accompanying these symptoms [2][3][4][5]; these conditions vary widely and include polyradiculitis, myelopathy, encephalitis, or meningitis [6], brain or epidural abscess [7,8], injury of cranial nerve [3,[9][10][11], transient ischemic attack and other vascular diseases [12,13], altered mental status [14]. Parkinsonian-like tremor is rare.…”