Acewicz Albert, Witkowski Grzegorz, Rola Rafal, Ryglewicz Danuta, Sienkiewicz-Jarosz Halina
First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Neurol Neurochir Pol. 2017 Mar-Apr;51(2):180-183. doi: 10.1016/j.pjnns.2016.12.004. Epub 2017 Jan 10.
We describe a case of 52-year-old woman with a medical history of Crohn's disease presented abrupt fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem. The patient was initially diagnosed with ischaemic stroke, because of acute clinical course and results of neuroimaging. Cerebrospinal fluid analysis revealed mild infection with negative Gram staining and culture. Final diagnosis of Listeria monocytogenes brainstem infection (rhombencephalitis) was set up on the basis of further clinical course and positive blood cultures. Listerial rhombencephalitis should be kept in mind in immunocompromised adult patients who develop fever, asymmetrical multiple cranial nerve palsies and focal neurological symptoms localized to the brainstem even without typical neuroimaging, cerebrospinal fluid findings and negative cultures. Early diagnosis and adequate antibiotic treatment is of crucial importance.
我们描述了一例52岁患有克罗恩病病史的女性，该患者出现突发发热、不对称性多发颅神经麻痹以及局限于脑干的局灶性神经症状。由于急性临床病程和神经影像学检查结果，该患者最初被诊断为缺血性卒中。脑脊液分析显示轻度感染，革兰氏染色和培养均为阴性。基于进一步的临床病程和血培养阳性，最终诊断为单核细胞增生李斯特菌脑干感染（菱形脑炎）。对于出现发热、不对称性多发颅神经麻痹以及局限于脑干的局灶性神经症状的免疫功能低下成年患者，即使没有典型的神经影像学表现、脑脊液检查结果及培养阴性，也应考虑李斯特菌菱形脑炎。早期诊断和充分的抗生素治疗至关重要。
