Overview
Brucella infection affecting the central nervous system (CNS) manifests primarily as neurobrucellosis, characterized by meningitis, meningoencephalitis, and rarely, complications such as cerebral venous sinus thrombosis and thalamic infarction 12.Diagnosis
Clinical Presentation: Severe and persistent headache, cranial nerve palsies, papilledema, and neurological deficits 12.
Laboratory Tests:
- Serological testing (ELISA) for Brucella antibodies in serum and cerebrospinal fluid (CSF) 12.
- CSF analysis showing pleocytosis, elevated protein, and decreased glucose levels 1.
Imaging: MRI or MRV to identify structural abnormalities like cerebral venous sinus thrombosis or infarctions 12.Management
First-Line Treatment:
- Protracted polymicrobial antibiotic therapy, typically including doxycycline, rifampin, and gentamicin (duration and specific dosing not detailed in abstracts) 1.
Adjunctive Therapy:
- Anticoagulation with heparin for concurrent cerebral venous sinus thrombosis 1.Special Populations
Travel History: Consider neurobrucellosis in patients with a history of travel to endemic regions presenting with unresponsive meningitis or meningoencephalitis 2.Key Recommendations
Consider neurobrucellosis in patients with severe, persistent neurological symptoms and a history of travel to endemic areas (Evidence: Moderate 2).
Utilize serological tests (ELISA) in serum and CSF for diagnosing Brucella infection when clinical suspicion is high (Evidence: Moderate 12).
Initiate prolonged antibiotic therapy targeting Brucella species for confirmed cases (Evidence: Weak 1).
Manage concurrent cerebral venous sinus thrombosis with anticoagulation therapy (Evidence: Weak 1).References
1 Ibrahimagić OĆ, Smajlović D, Dostović Z, Iljazović A, Kojić B, Zonić L. Neurobrucellosis and cerebral venous sinus thrombosis: a case report. Acta clinica Belgica 2017. link
2 Jochum T, Kliesch U, Both R, Leonhardi J, Bär KJ. Neurobrucellosis with thalamic infarction: a case report. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2008. link