Neurobrucellosis presenting as a diffuse involvement of cerebellum, brainstem, spinal cord and cauda equina
patient symptoms initiated with intermittent fever and chills accompanied by fatigue. About 9 months later, she developed low back pain, paresthesia of inguinal and genital areas and lower extremities weakness progressing from distal to proximal.
In brain MRI abnormal hyperintense T2 and FLAIR lesions were seen in bilateral superior cerebellar peduncles which showed post-contrast patchy enhancement . Moreover, there were a few small abnormal signal foci in central pontine area and midbrain . Spinal T2 weighted axial and sagittal MRI revealed a diffused intramedullary hyperintensity lesion throughout the cervical and thorasic spinal cord which showed post-contrast patchy enhancement. In post-contrast lumbosacral MRI, radicular enhancement was detected in cauda equine.
Brucellosis is a common health problem in developing countries and neurobrucellosis is one of the important complications of it. Neurobrucellosis may have widely variable manifestations and the diagnosis may be difficult. So patients with neurologic signs should be considered for potential neurobrucellosis in endemic regions. According to diagnostic criteria imaging studies are not necessary for confirm neurobrucellosis, but they could be useful for determine the extension of neurological involvement, diagnosis of some conditions that might need special treatment such as abscess formation and could be helpful to exclude other differential diagnosis.