Rapid detection of Listeria monocytogenes rhombencephalitis in an immunocompetent patient by multiplexed PCR

A 46-year-old previously healthy man presented with 1 week of headache, nausea, vomiting and dizziness. He was found to have cranial nerve deficits, his cerebrospinal fluid (CSF) demonstrated a lymphocytic pleocytosis and brain MRI suggested rhombencephalitis. Although Gram stains and cultures of his CSF did not identify a pathogen, Listeria monocytogenes DNA was detected by the FilmArray Meningitis/Encephalitis panel within 2 hours of performing a lumbar puncture. He was treated with ampicillin and gentamicin and had a near-complete recovery. This case highlights the importance of recognising L. monocytogenes infection as a cause of acute cranial nerve impairment with MRI findings suggestive of brainstem encephalitis. It also highlights the frequently atypical CSF profile and low yield of culture in L. monocytogenes rhombencephalitis and the value of multiplex PCR testing of CSF to rapidly identify this pathogen and permit targeted therapy.

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Listeria monocytogenes meningitis in an immunocompetent 18-year old patient as a possible diagnostic and therapeutical problem

Vojnosanitetski pregled ◽

10.2298/vsp1310976v ◽

2013 ◽

Vol 70 (10) ◽

pp. 976-978

Author(s):

Miodrag Vrbic ◽

Marina Dinic ◽

Maja Jovanovic ◽

Aleksandar Rankovic ◽

Lidija Popovic-Dragonjic ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Listeria Monocytogenes ◽

Bacterial Meningitis ◽

Initial Treatment ◽

Clinical Effect ◽

Complete Recovery ◽

Cell Mediated Immunity ◽

The Third ◽

Appropriate Treatment

Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

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About pathognomonic images: an infrequent case of acute encephalopathy

Italian Journal of Medicine ◽

10.4081/itjm.2008.3.39 ◽

2013 ◽

pp. 39-41

Author(s):

Alessandro Grasso ◽

Pietro Nurra ◽

Luigia Cavallo ◽

Giorgio Menardo

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Brain Mri ◽

Acute Diarrhoea ◽

Complete Recovery ◽

Diagnostic Techniques ◽

Clinical Event ◽

Acute Encephalopathy ◽

Wernicke Encephalopathy ◽

Cerebral Mri

BACKGROUND The occurrence of acute encephalopathy is a dramatic clinical dilemma when usual diagnostic techniques (blood tests, cerebral CT and cerebrospinal fluid analysis) show no abnormalities. CLINICAL CASE We describe a case of a 73 years old man admitted in our Internal Medicine Unit for acute diarrhoea with vomiting and fever who developed a prolonged gastrointestinal dysmotility syndrome with poor nutritional intake. Although a parenteral support was provided, he developed acute encephalopathy followed by hypotension and lactic acidosis without evidence of renal and hepatic disease or glycemic alterations. Likewise, no cerebral CT and cerebrospinal fluid alterations were found. Conversely, cerebral MRI showed marked and diffuse DP-2 and FLAIR hyperintensity of the mesencephalic tectal plate, of the periaqueductal area, and of the periventricular region of the third ventricle including the median thalamic area. These MRI descriptions were considered pathognomonic of Wernicke encephalopathy. Thus, the immediate use of ev thiamine was followed by a prompt and complete recovery of neurological, hemodinamic and metabolic conditions. CONCLUSIONS Non-alcoholic Wernicke encephalopathy is a rare and dramatic clinical event with high mortality. In this context, brain MRI is the best diagnostic tool providing a typical picture.

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Brainstem Encephalitis Caused by Listeria monocytogenes

Pathogens ◽

10.3390/pathogens9090715 ◽

2020 ◽

Vol 9 (9) ◽

pp. 715

Author(s):

Pengxu Wei ◽

Ruixue Bao ◽

Yubo Fan

Keyword(s):

Listeria Monocytogenes ◽

Early Recognition ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Good Health ◽

Enteric Neurons ◽

Brainstem Encephalitis ◽

Mri Findings ◽

Periodontal Tissues ◽

Magnetic Resonance Imaging Mri

International outbreaks of listerial infections have become more frequent in recent years. Listeria monocytogenes, which usually contaminates food, can cause potentially fatal infections. Listerial cerebritis is a rare disease that is encountered mostly in immunocompromised or elderly patients. However, listerial brainstem encephalitis (mesenrhombencephalitis or rhombencephalitis) is found in persons who were formerly in good health, and recognizing this disease, particularly at its early stages, is challenging. Listerial brainstem encephalitis has high mortality, and serious sequelae are frequently reported in survivors. Early recognition and correct diagnosis, as well as the timely use of appropriate antibiotics, can reduce the severity of listerial infections. The trigeminal nerve is proposed as a pathway through which L. monocytogenes reaches the brainstem after entering damaged oropharyngeal mucosa or periodontal tissues. This review introduces the clinical manifestations, pathology, magnetic resonance imaging (MRI) findings, diagnosis, and treatment of listerial brainstem encephalitis. Moreover, it proposes that L. monocytogenes may also invade the brainstem along the vagus nerve after it infects enteric neurons in the walls of the gastrointestinal tract.

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Cerebrospinal fluid features in COVID-19 patients with neurologic manifestations: correlation with brain MRI findings in 58 patients

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa745 ◽

2020 ◽

Author(s):

François Lersy ◽

Ilies Benotmane ◽

Julie Helms ◽

Olivier Collange ◽

Maleka Schenck ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Clinical Laboratory ◽

Brain Mri ◽

Oligoclonal Bands ◽

Neurologic Manifestations ◽

Neurological Manifestations ◽

Rt Pcr ◽

Mri Findings ◽

Leptomeningeal Enhancement ◽

Csf Analysis

Abstract Background Neurological manifestations are common in patients with COVID-19, but little is known about pathophysiological mechanisms. In this single-center study, we describe neurological manifestations of 58 patients, regarding cerebrospinal fluid (CSF) analysis and neuroimaging findings. Methods 58 COVID-19 patients with neurologic manifestations and SARS-CoV-2 RT-PCR screening on CSF analysis were included. Clinical, laboratory, and brain MRI data were retrospectively collected and analyzed. Results Patients were mostly men (66%) with a median age of 62 years. Encephalopathy was frequent (81%), followed by a pyramidal dysfunction (16%), seizures (10%), and headaches (5%). Protein and albumin levels in CSF were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient suggesting impaired blood-brain barrier integrity. CSF-specific IgG oligoclonal band was found in five (11%) cases, suggesting an intrathecal synthesis of IgG, and 26 (55%) patients presented identical oligoclonal bands in serum and CSF. Four (7%) patients harbored a positive SARS-CoV-2 RT-PCR in CSF. Regarding brain MRI, 20 (38%) patients presented leptomeningeal enhancement. Conclusions Brain MRI abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV 2 detection in CSF remained scanty.

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Clinical and magnetic resonance analysis of varicella-zoster virus (VZV) transcranial nerve into brain-induced brainstem encephalitis

10.21203/rs.2.18230/v1 ◽

2019 ◽

Author(s):

Jingzhe Han ◽

Yanan Xie ◽

Zhilei Kang ◽

Huiqing Zhang

Keyword(s):

Cerebrospinal Fluid ◽

Blood Glucose ◽

Magnetic Resonance ◽

Liver Function ◽

Varicella Zoster Virus ◽

Cranial Nerve ◽

White Blood Cells ◽

Brainstem Encephalitis ◽

Varicella Zoster ◽

Life Threatening

Abstract Background: In this study, we summarize the clinical and magnetic resonance characteristics of patients with varicella-zoster virus transcranial brain-induced brainstem encephalitis. Methods: The patient's baseline data meet the inclusion criteria were collected. All patients were admitted to the hospital for routine blood, urine, and stool, blood glucose, blood pressure, blood lipids, homocysteine, liver function, renal function, electrolytes, eight items before the operation, autoantibodies, 24-hour dynamic EEG. All patients underwent a head MRI scan, and the patients underwent lumbar puncture, perfecting routine cerebrospinal fluid, biochemical and cytological examinations, and high-throughput examination of cerebrospinal fluid pathogens. Result: Seven patients were enrolled in this study. All patients were associated with skin herpes in the area of cranial nerve distribution. Herpes is complicated with V-cranial nerve in 1 case, facial nerve (6 cases), vestibular nerve (5 cases), tongue pharynx, vagus nerve (1 case). The interval of central nervous system injury after 6 cases of skin herpes were 3-20 days. Laboratory and EEG examinations showed that all patients had no abnormalities in autoantibodies and preoperative eight items; low blood routines showed elevated white blood cells in 4 cases, elevated blood glucose in 4 cases, and abnormal liver function in 2 cases. Magnetic resonance imaging showed the disease involved 2 cases of the dorsolateral medulla, 6 cases with bridge arm, 1 case with multiple lesions, and 1 case without abnormal findings. Conclusion: CZV-induced cranial nerve palsy and encephalitis can leave serious sequelae, even life-threatening, early diagnosis and early treatment are essential. For VZV infections confined to the cranial nerve, MRI is necessary even without evidence of brain stem injury, especially DWI sequences and 3D-CISS imaging can show extent of affected early cranial nerve.

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Meningoencephalitis due to Spotted Fever Rickettsioses, Including Rocky Mountain Spotted Fever

Clinical Infectious Diseases ◽

10.1093/cid/ciz776 ◽

2019 ◽

Vol 71 (1) ◽

pp. 188-195 ◽

Cited By ~ 1

Author(s):

Michael J Bradshaw ◽

Kelly Carpenter Byrge ◽

Kelsey S Ivey ◽

Sumit Pruthi ◽

Karen C Bloch

Keyword(s):

Early Recognition ◽

Spotted Fever ◽

Brain Mri ◽

Rocky Mountain ◽

Complete Recovery ◽

High Morbidity ◽

Rocky Mountain Spotted Fever ◽

Mri Findings ◽

Empiric Treatment ◽

Adults And Children

Abstract Background The spotted fever rickettsioses (SFR), including Rocky Mountain spotted fever, are tick-borne infections with frequent neurologic involvement. High morbidity and mortality make early recognition and empiric treatment critical. Most literature on SFR meningoencephalitis predates widespread magnetic resonance imaging (MRI) utilization. To better understand the contemporary presentation and outcomes of this disease, we analyzed clinical and radiographic features of patients with SFR meningoencephalitis. Methods Patients were identified through hospital laboratory-based surveillance or through the Tennessee Unexplained Encephalitis Study. Cases meeting inclusion criteria underwent medical records review and, when available, independent review of the neuroimaging. Results Nineteen cases (11 children, 8 adults) met criteria for SFR meningoencephalitis. Rash was significantly more common in children than adults (100% vs 50%, respectively), but other clinical features were similar between the 2 groups. Cerebrospinal fluid pleocytosis and protein elevation were each seen in 87.5% of cases, and hypoglycorrhachia was present in 18.8% of cases. The “starry sky” sign (multifocal, punctate diffusion restricting or T2 hyperintense lesions) was seen on MRI in all children, but no adults. Ninety percent of patients required intensive care unit admission and 39% were intubated. Outcomes were similar between adults and children, with only 46% making a complete recovery by the time of discharge. Conclusions SFR meningoencephalitis is a life-threatening infection. The clinical presentation varies between adults and children based on the presence of rash and brain MRI findings. The starry sky sign was ubiquitous in children and should prompt consideration of empiric treatment for SFR when present.

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Recurrent Painful Ophthalmoplegic Neuropathy and Oculomotor Nerve Schwannoma: A Pediatric Case Report with Long-Term MRI Follow-Up and Literature Review

Pain Research and Management ◽

10.1155/2019/5392945 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Maria Giuseppina Petruzzelli ◽

Mariella Margari ◽

Flora Furente ◽

Maria Carmela Costanza ◽

Anna Rosi Legrottaglie ◽

...

Keyword(s):

Cranial Nerve ◽

Brain Mri ◽

Oculomotor Nerve ◽

Childhood Onset ◽

Mri Findings ◽

Long Term Follow Up ◽

Recurrent Painful Ophthalmoplegic Neuropathy

Background. Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is an uncommon disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache. The age of presentation is most often during childhood or adolescence. MRI has a central role in the assessment of the RPON, especially to distinguish orbital, parasellar, or posterior fossa lesions that mimic symptoms of RPON. Actually, oculomotor nerve tumors may be masquerade as RPON so that MRI follow-ups are required to detect the possibility of tumor etiology. Case presentation. We report a 16-year-old boy with a 7-year follow-up and multiple brain MRI data, previously diagnosed as OM. The last brain MRI, performed during an acute phase of oculomotor paresis with ipsilateral headache, showed a nodular lesion described as schwannoma of III cranial nerve. Then, we reviewed the literature on OM and RPON in pediatric age with a focus on brain MRI findings. Conclusions. This review highlights the important role of serial brain MRIs in the long-term follow-up of RPON, especially in the cases with childhood onset, in order to not delay the diagnosis of a possible oculomotor nerve schwannoma.

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Brain MRI findings in non-ketotic hyperglycemic crisis: Case report

Case reports ◽

10.15446/cr.v6n2.83866 ◽

2020 ◽

Vol 6 (2) ◽

pp. 146-155

Author(s):

Laura Estefanía Arenas-Vargas ◽

Ruben Darío Arenas-Diaz ◽

Enrique Hernandez-Rojas ◽

Fabián Riaño-Montañez

Keyword(s):

Cerebrospinal Fluid ◽

Metabolic Disorders ◽

Brain Mri ◽

Clinical Manifestations ◽

Epileptic Seizures ◽

Mri Findings ◽

Diffusion Restriction ◽

Parietal Lobes ◽

Neurological Alterations ◽

Neuroimaging Techniques

Introduction: Seizures related to metabolic disorders are common phenomena in many clinical contexts. However, clinical manifestations and neuroimaging findings in the context of a hyperglycemic crisis are less frequent phenomena with unclear pathophysiology.Case report: A 68-year-old man presented focal seizures and right homonymous hemianopsia after a non-ketotic hyperglycemic crisis. Brain MRI showed cortical diffusion restriction and subcortical T2 / FLAIR hypointensity in left occipital, temporal (mesial) and parietal lobes. Spectroscopy was performed showing a nonspecific pattern, cerebrospinal fluid was normal and there was improvement with glycemic control. MRI findings were considered secondary to the hyperglycemic crisis.Conclusion: Non-ketotic hyperglycemic states can manifest with several rare neurological alterations and recognizing them early is of vital importance given their potential reversibility. As in other metabolic disorders, epileptic seizures in this context can have focal-type characteristics. Although pathophysiological mechanisms are not clearly elucidated yet, multiple neuroimaging techniques promise to establish patterns that allow accurate and timely diagnosis.

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Brain MRI-findings in Ph - negative myeloproliferative disorders

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.07.000329 ◽

2019 ◽

Vol 91 (7) ◽

pp. 29-34 ◽

Cited By ~ 2

Author(s):

M M Tanashyan ◽

A L Melikyan ◽

P I Kuznetsova ◽

A A Raskurazhev ◽

A A Shabalina ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Sinus Thrombosis ◽

Cerebral Arteries ◽

Brain Mri ◽

Myeloproliferative Disorders ◽

Cerebral Venous Sinus Thrombosis ◽

Mri Findings ◽

Cerebral Lesions ◽

Cerebrovascular Pathology ◽

Underlying Mechanisms

Myeloproliferative disorders (MPD) are accompanied by a high proportion of thrombotic complications, which may lead to cerebrovascular disease (CVD). Aim. To describe MRI-findings in patients with Ph - negative MPD and evaluate any cerebrovascular disease. Materials and methods. We included 104 patients with Ph - negative MPD (age varied between 20 and 58) with clinical correlates of cerebrovascular pathology. Results. Brain MRI showed post - stroke lesions in 20% of patients (7 hemispheric infarcts due to thrombotic occlusion of one of the large cerebral arteries, 14 - cortical infarcts). 37 patients (36%) had vascular cerebral lesions. Cerebral venous sinus thrombosis occurred in 5 patients - in 7% (n=3) of patients with polycythemia vera and 5% (n=2) - in patients with essential thrombocythemia. The incidence of vascular cerebral lesions was associated with higher levels of the following: erythrocyte, platelet count, fibrinogen, and with the decrease in fibrinolytic activity, as well. Conclusion. The pioneering results of the study include the description and analysis of brain MRI-findings in patients with Ph - negative MPD. The underlying mechanisms of cerebrovascular pathology in these patients are associated with certain blood alterations (particularly, hemorheology) which present a major risk factor.

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