Clinical and radiologic manifestations and CSF analysis of neurobrucellosis in 23 patients

Patient No./Age (y)/SexSigns and SymptomsImaging FindingsWhite Blood Cell Count (WBC)CSF Analysis
Protein (mg/L)Brucella* (SAT, 2ME)
1/26/MHeadache, ↓hearing, psychosisMR brain: normal.4603320, 160
2/51/MConfusion, spastic gait, ↓hearingMR: periventricular white matter hyperintense lesion (T2 + FLAIR).6692160, 80
3/30/FHeadache, deafness, papilledema, sensory ataxia, areflexiaMR brain: enhancing granuloma suprasellar region (T1 + contrast).37380001280, 640
4/59/MFever, ↓hearing, ataxia, lower limb weakness, areflexia, BabinskiCT brain: normal. MR brain: periventricular white matter hyperintense lesions (T2 + FLAIR).701900320, 320
5/25/MDeafnessMR brain: normal.152140, 40
6/36/M↓Hearing, ataxia, nystagmusCT brain: normal. MR brain: basal meningeal enhancement (T1 + contrast).2198300640, 640
7/32/M↓Hearing, spasticity, bilateral BabinskiMR brain: right frontal subcortical high signal intensity (T2).61093640, 640
8/29/FDeafnessMR brain: normal.821900640, 320
9/32/M↓Hearing, lower limb weakness, areflexiaMR lumbar spine: enhancement of nerve root (T1 + contrast).27066371280, 640
10/58/MFever, ↓hearing, ataxiaCT brain: normal.49079301280, 1280
11/17/MFever, lower limb weakness, areflexiaMR lumbar spine: enhancement of nerve root (T1 + contrast).652308160, 160
12/28/F↓HearingCT brain: normal.2074780, 80
13/50/MConfusion, seizures, behaviour change, ↓hearingCT brain: bihemisphere white matter hypoattenuation, left caudate lacunae, subthalamic hematoma. MR: diffuse white matter hyperintense lesions (T2 + FLAIR), caudate lacunae, increased signal intensity in pons and left cerebral peduncle (T2).9007536180, 80
14/70/M↓Hearing, spastic paraparesis, ataxic gaitMR brain: diffuse white matter hyperintense lesions (T2 + FLAIR) and basal meningeal enhancement (T1 + contrast). MR spine: normal.172641160, 160
15/30/FHeadache, sixth nerve palsy, papilledema, ↓hearingMR and CT: normal.5002370640, 640
16/30/MHeadache, sixth nerve palsy, papilledema, ↓hearing, neck stiffnessMR: normal.4288040, 20
17/29/M↓Hearing, spastic paraparesisMR brain: normal. MR spine: atrophy.1460320, 160
18/32/F↓HearingMR: normal.61599320, 320
19/25/F↓Hearing, headacheMR: normal.15215380, 80
20/63/MRecurrent transient ischemic attacks, confusion, ↓hearingCT: periventricular hypoattenuations, enhancement of tentorium. MR: periventricular white matter hyperintense lesions (T2 + FLAIR), right cerebellum and pons increased signal intensity (T2).150100080, 80
21/65/FHeadache, confusion, neck stiffnessMR: diffuse white matter hyperintense lesions (T2 + FLAIR), left caudate lacunae.2722000640, 640
22/20/FLower limb weakness, areflexiaMR spine: lumbar nerve root enhancement (T1 + contrast).3217971280, 640
23/47/F↓Hearing, lower limb weakness, areflexiaMR spine: normal.Not performed

  • Note.—↓ indicates decreased; T2, T2-weighted images; T1 + contrast, gadolinium-enhanced T1-weighted images.

  • * By standard agglutination test before and after precipitation by 2-mercapto-ethanol.