[Refractory epilepsy as the presenting symptom of a brucellar brain abscess]. / Epilepsia refractaria como presentacioón de absceso cerebral brucelósico.

INTRODUCTION: Brucellosis is a zoonotic disease that is occasionally transmitted to human beings from infected animal reservoirs. It is an important condition in endemic areas. One infrequent complication of systemic brucellosis is the infection of the central or the peripheral nervous systems. CASE REPORT: A 54-year-old male who was being studied prior to surgery for refractory epilepsy, with clinical expression in the form of complex partial seizures. Neuroimaging findings revealed an expansive lesion in the right temporal lobe, which direct serological, histopathological and microbiological evidence showed to be a chronic brucellar abscess. After combined treatment involving complete surgical resection followed by a cycle of standard antimicrobial therapy, the patient was seizure-free at one year of follow-up. CONCLUSIONS: Despite its low frequency, infection by Brucella must be considered in the differential diagnosis of intracranial expansive lesions, as well as in the case of patients whose presenting symptoms are epileptic seizures. To perform the diagnosis it is especially important to be aware of the wide range of clinical and radiological manifestations that can be produced, and which do not always correlate. Identification of risk factors on the patient record is also a crucial step.

Epilepsia refractaria como presentación de absceso cerebral brucelósico / Refractory epilepsy as the presenting symptom of a brucellar brain abscess

Introducción. La brucelosis es una enfermedad zoonósicaque se transmite de forma ocasional al ser humano desde reservoriosanimales infectados. Representa una entidad de relevanciaen áreas endémicas. Una complicación poco frecuente de la brucelosissistémica es la infección del sistema nervioso, tanto centralcomo periférico. Caso clínico. Varón de 54 años en estudio prequirúrgicode epilepsia refractaria, con expresión clínica en forma decrisis parciales complejas, en el cual se demostró mediante técnicasde neuroimagen una lesión expansiva en el lóbulo temporal derecho,filiada como absceso crónico brucelósico mediante demostraciónserológica, histopatológica y microbiológica directa. Tras eltratamiento combinado mediante resección quirúrgica completa,seguido de un ciclo de tratamiento antimicrobiano, el paciente quedólibre de crisis tras un año de seguimiento. Conclusiones. A pesarde su baja frecuencia, la infección por Brucella debe considerarseen el diagnóstico diferencial de las lesiones expansivas intracraneales,así como en los pacientes cuya forma de presentación son lascrisis epilépticas. Para la realización del diagnóstico es de especialimportancia el conocimiento de la amplia variedad de manifestacionesclínicas y radiológicas a las que puede dar lugar, y que nosiempre encuentran correlato, así como la identificación de factoresde riesgo en la historia clínica

Introduction. Brucellosis is a zoonotic disease that is occasionally transmitted to human beings from infectedanimal reservoirs. It is an important condition in endemic areas. One infrequent complication of systemic brucellosis is theinfection of the central or the peripheral nervous systems. Case report. A 54-year-old male who was being studied prior tosurgery for refractory epilepsy, with clinical expression in the form of complex partial seizures. Neuroimaging findingsrevealed an expansive lesion in the right temporal lobe, which direct serological, histopathological and microbiologicalevidence showed to be a chronic brucellar abscess. After combined treatment involving complete surgical resection followedby a cycle of standard antimicrobial therapy, the patient was seizure-free at one year of follow-up. Conclusions. Despite itslow frequency, infection by Brucella must be considered in the differential diagnosis of intracranial expansive lesions, as wellas in the case of patients whose presenting symptoms are epileptic seizures. To perform the diagnosis it is especially importantto be aware of the wide range of clinical and radiological manifestations that can be produced, and which do not alwayscorrelate. Identification of risk factors on the patient record is also a crucial step