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Teaching NeuroImages: Deep gray matter involvement in neurobrucellosis.
MedLine Citation:
PMID:  23319480     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
A 27-year-old man, recent visitor to the Middle East, presented with 6-week history of fever (up to 102°F) followed by altered behavior and left hemiparesis. CSF was acellular with raised protein (138 mg/dL). CSF bacterial culture was sterile; adenosine deaminase normal (3 U/L); cryptococcal antigen, Venereal Disease Research Laboratory test, and Japanese B serology were negative. HIV serology and vasculitic workup were unremarkable. Serum Brucella agglutination titer was 320 IU (immunoglobulin M fraction 280 IU). Cranial MRI showed nonenhancing bilateral white matter and basal ganglia hyperintensities on T2-weighted images (figure, A-C). The patient was treated with IV ceftriaxone (1 month) along with oral doxycycline and rifampicin (4 months). At 3 months, Brucella agglutination titer was <20 IU and the patient became independent. Follow-up imaging showed a reduction in lesions (figure, D). Brucellosis frequently presents as chronic meningitis along with cranial neuropathies and spinal arachnoiditis.(1) Demyelinating lesions are described in neurobrucellosis,(1,2) involvement of the deep gray matter being unusual.
Authors:
Roopa Rajan; Dheeraj Khurana; Praveen Kesav
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurology     Volume:  80     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e28-9     Citation Subset:  AIM; IM    
Affiliation:
From the Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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