Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study

• DOI: 10.1007/s15010-016-0901-3
• Publication Date: 2016-05-02T14:55:13Z
• Authors: Hakan Erdem; Seniha Senbayrak; Kaan Meriç; Ayşe Batirel; Mustafa Kasım Kar...; Rodrigo Hasbun; Gonul Sengoz; Hasan Karsen; Selçuk Kaya; Ayşe Seza Inal; Abdullah Umut Pekok; Mustafa Kemal Celen; Secil Deniz; Mehmet Ulug; Tuna Demirdal; Mustafa Namiduru; Recep Tekin; Tumer Guven; Emine Parlak; Sibel Bolukcu; Meltem Avci; Oguz Reşat Sipahi; Derya Ozturk-Engin; Kadriye Yaşar; Filiz Pehlivanoglu; Emel Yilmaz; Selma Ates-Guler; Esmeray Mutlu-Yilmaz; Selma Tosun; Fatma Sirmatel; Elif Sahin-Horasan; Ayhan Akbulut; Nefise Oztoprak; Yasemin Cag; Ayten Kadanali; Huseyin Turgut; Ali Irfan Baran; Hanefi Cem Gul; Mahmut Sunnetcioglu; Asli Haykir-Solay; Affan Denk; Asuman Inan; Celal Ayaz; Asim Ulcay; Sukran Kose; Canan Agalar; Nazif Elaldi
• Keywords: Male; Turkey; Turkey (republic); computer assisted tomography; 0302 clinical medicine; Diagnosis; middle aged; Prevalence; glucose; nuclear magnetic resonance imaging; granuloma; brain disease; brain edema; cranial nerve; protein cerebrospinal fluid level; Brain Diseases; neuroimaging; adult; spinal root; Middle Aged; Magnetic Resonance Imaging; 3. Good health; brain abscess; aged; female; brucellosis; young adult; brain infection; Female; Neurobrucellosis; hydrocephalus; white matter; Adult; Adolescent; diagnostic imaging; prevalence; Adolescent; Adult; Aged; Brain Diseases/diagnostic imaging/*pathology; Brucella/physiology; Brucellosis/diagnostic imaging/*epidemiology/microbiology/pathology; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; Prevalence; Tomography, X-Ray Computed; Turkey/epidemiology; Young Adult; 610; Neuroimaging; Article; Brucellosis; neurobrucellosis; Young Adult; 03 medical and health sciences; Magnetic resonance imaging; male; 616; x-ray computed tomography; Humans; controlled study; human; lymphocyte count; radiculopathy; Aged; Inflammation; microbiology; Computerized tomography; major clinical study; Brucella; arachnoiditis; glucose blood level; adolescent; cerebrospinal fluid level; physiology; pathology; polyneuropathy; protein; Tomography, X-Ray Computed

Neuroimaging abnormalities in central nervous system (CNS) brucellosis are not well documented. The purpose of this study was to evaluate the prevalence of imaging abnormalities in neurobrucellosis and to identify factors associated with leptomeningeal and basal enhancement, which frequently results in unfavorable outcomes.Istanbul-3 study evaluated 263 adult patients with CNS brucellosis from 26 referral centers and reviewed their 242 magnetic resonance imaging (MRI) and 226 computerized tomography (CT) scans of the brain.A normal CT or MRI scan was seen in 143 of 263 patients (54.3 %). Abnormal imaging findings were grouped into the following four categories: (a) inflammatory findings: leptomeningeal involvements (44), basal meningeal enhancements (30), cranial nerve involvements (14), spinal nerve roots enhancement (8), brain abscesses (7), granulomas (6), and arachnoiditis (4). (b) White-matter involvement: white-matter involvement (32) with or without demyelinating lesions (7). (c) Vascular involvement: vascular involvement (42) mostly with chronic cerebral ischemic changes (37). (d) Hydrocephalus/cerebral edema: hydrocephalus (20) and brain edema (40). On multivariate logistic regression analysis duration of symptoms since the onset (OR 1.007; 95 % CI 1-28, p = 0.01), polyneuropathy and radiculopathy (OR 5.4; 95 % CI 1.002-1.013, p = 0.044), cerebrospinal fluid (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) were associated with diffuse inflammation.In this study, 45 % of neurobrucellosis patients had abnormal neuroimaging findings. The duration of symptoms, polyneuropathy and radiculopathy, high CSF protein level, and low CSF/serum glucose rate were associated with inflammatory findings on imaging analyses.