Overview
Listerial cerebral arteritis is a rare but severe inflammatory condition affecting cerebral arteries, often associated with systemic listeriosis or, as seen in the case, illicit drug use like heroin, leading to focal neurological deficits and vascular complications 1.Diagnosis
Clinical Presentation: Sudden onset of focal neurological deficits (e.g., homonymous hemianopia) 1.
Imaging: MRI or CT showing infarction; angiography revealing characteristic arteritis changes 1.
Laboratory Tests: Blood cultures for Listeria monocytogenes, inflammatory markers (elevated ESR, CRP) 1.
Specific Testing: Listeria-specific PCR or serology if clinical suspicion is high 1.Management
Antimicrobial Therapy: Initiate broad-spectrum antibiotics pending culture results, then tailor to Listeria if identified (e.g., ampicillin or amoxicillin-clavulanate) 1.
Steroids: Consider corticosteroids to reduce inflammation, though evidence is limited 1.
Supportive Care: Management of complications including seizures, hypertension, and rehabilitation 1.Special Populations
Heroin Abuse: Increased risk in individuals with a history of heroin use; specific management considerations may include addressing substance use disorder 1.Key Recommendations
Prompt initiation of broad-spectrum antibiotics and specific Listeria coverage based on clinical suspicion and laboratory results (Evidence: Moderate 1).
Angiographic evaluation is crucial for diagnosing cerebral arteritis in patients with focal neurological deficits following illicit drug use (Evidence: Weak 1).
Consider corticosteroid therapy to manage inflammation, though robust evidence is lacking (Evidence: Expert opinion 1).References
1 King J, Richards M, Tress B. Cerebral arteritis associated with heroin abuse. The Medical journal of Australia 1978. link