Zhang Yu, Zou Xiao-Yi, Liu Ling
Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China.
Front Immunol. 2025 Jan 7;15:1449909. doi: 10.3389/fimmu.2024.1449909. eCollection 2024.
Neurobrucellosis is a rare neurological disorder characterized by diverse clinical manifestations. Although several relevant cases were reported, our understanding of this disorder is limited. In this study, we presented the clinical and imaging characteristics of four cases of neurobrucellosis.
Four patients with neurobrucellosis were diagnosed and treated in the West China Hospital of Sichuan University and Chengdu Shangjin Nanfu Hospital, from January 2020 to September 2023. Data on demographics, clinical phenotypes and symptoms, cerebrospinal fluid investigations, radiological investigations, and therapies were collected and reviewed. This study was approved by and conducted in accordance with the recommendations of West China Hospital's ethics -.1clinical manifestations of neurobrucellosis in these patients included meningitis, meningoencephalitis, encephalitis, cranial neuropathy, intracranial hypertension, radiculitis, peripheral neuropathy, myelitis, and other psychiatric symptoms. species were isolated from blood or cerebrospinal fluid (CSF) in four patients; three patients had elevated CSF protein levels, and two had elevated CSF leukocyte counts. All four patients had abnormal imaging findings, including meningeal signs, abnormal cortex and subcortical white matter signals, and signal abnormalities in the vertebral body and spinal cord. All patients were treated with rifampicin (450 mg once daily) and minocycline (100 mg twice daily) for at least 12 weeks, and their clinical symptoms showed significant improvements.
This report reviews four cases of neurobrucellosis. All four patients had headache, fever, seizure, cranial nerve damage, low back pain, along with imaging abnormalities, and were successfully treated with antibiotics. The symptoms of neurobrucellosis can be insidious, mild, and non-specific, characterized by various clinical manifestations and atypical imaging findings. This complexity increases the risk of misdiagnosis and missed diagnosis; thus, careful identification, extended treatment, and close follow-up are required.
神经型布鲁氏菌病是一种罕见的神经系统疾病，临床表现多样。尽管已有多例相关病例报道，但我们对该疾病的了解仍然有限。在本研究中，我们展示了4例神经型布鲁氏菌病的临床和影像学特征。
2020年1月至2023年9月期间，四川大学华西医院和成都上锦南府医院诊断并治疗了4例神经型布鲁氏菌病患者。收集并回顾了患者的人口统计学数据、临床表型和症状、脑脊液检查、影像学检查及治疗情况。本研究经华西医院伦理委员会批准，并按照其建议进行。这些患者神经型布鲁氏菌病的临床表现包括脑膜炎、脑膜脑炎、脑炎、颅神经病变、颅内高压、神经根炎、周围神经病变、脊髓炎及其他精神症状。4例患者的血液或脑脊液中分离出布鲁氏菌；3例患者脑脊液蛋白水平升高，2例患者脑脊液白细胞计数升高。所有4例患者均有影像学异常表现，包括脑膜征、皮质及皮质下白质信号异常、椎体及脊髓信号异常。所有患者均接受利福平（每日1次，每次450mg）和米诺环素（每日2次，每次100mg）治疗至少12周，临床症状均有明显改善。
本报告回顾了4例神经型布鲁氏菌病病例。所有4例患者均有头痛、发热、癫痫发作、颅神经损害、腰痛及影像学异常，经抗生素治疗均获成功。神经型布鲁氏菌病的症状可能隐匿、轻微且不具特异性，临床表现多样，影像学表现不典型。这种复杂性增加了误诊和漏诊的风险；因此，需要仔细甄别、延长治疗时间并密切随访。
