Background: Imaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The aim of this study was to evaluate the neuroimaging abnormalities of neurobrucellosis.
Methods: This study evaluated 263 adult patients with CNS brucellosis from 26 referral centers. We reviewed 242 magnetic resonance imaging (MRI) data and 226 computerized tomography (CT) scans of brain in 263 patients.
Results: In 261 (99%) patients, at least one serologic test for Brucella was positive. Cerebrospinal fluid (CSF) Rose-Bengal test (RBT) was positive in 68% (93 /136 of tested), CSF standard tube agglutination (STA) test was positive 88% (185/211). Brucella spp were isolated from the CSF in 36 of 233 patients (15%).
A normal CT or (MRI) findings were detected in 143 of 263 patients (54.3%). Abnormal imaging findings were grouped into the following four categories: Inflammation: This group included leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). White matter changes: This group included white matter changes (32) and demyelinating lesions (7). Vascular findings: This group had vascular changes (42) and chronic cerebral ischemic changes (39). Hydrocephalus/cerebral edema: This group included hydrocephalus (20) and brain edema (40). Multivariate logistic regression analysis disclosed that duration of symptoms since the onset (OR 1.007;95% CI 1-28, p=0.01), the presence of polyneuropathy and radiculopathy (OR 5.4;95% CI 1.002-1.013, p=0.044), CSF/serum glucose rate (OR 0.001;95% CI 000-0.067, p=0.001), and CSF protein (OR 2.5;95% CI 2.3-2.7, p=0.0001) indicated CNS inflammation in imaging analyses.
Conclusion: In this study, inflammatory changes were the primary abnormality followed by vascular changes in CNS brucellosis. Duration of symptoms, the presence of polyneuropathy and radiculopathy, a high CSF protein level, and a low CSF/serum glucose rate are the most suggestive parameters for inflammation detected with imaging techniques.
K. Meric, None
A. Ulcay, None
A. Batirel, None
M. K. Karahocagil, None
R. Hasbun, Medicine''s Company: Speaker's Bureau , Speaker honorarium
Cubist: Speaker's Bureau , Speaker honorarium
Theravance: Speaker's Bureau , Speaker honorarium
Pfizer: Speaker's Bureau , Speaker honorarium
G. Sengoz, None
H. Karsen, None
S. Kaya, None