ABSTRACT
The term rhombencephalitis refers to inflammatory diseases affecting the hindbrain (brainstem and cerebellum). Rhombencephalitis has a wide variety of etiologies, some of them potentially severe and life threatening without proper early treatment. In this retrospective observational study, we reviewed the records of consecutively hospitalized patients at University Hospital of Bellvitge (Barcelona, Spain) from January 1990 to December 2008. Rhombencephalitis was defined as a brainstem and/or cerebellar condition demonstrated clinically or by neuroimaging, with pleocytosis (>4 cells/mm) in cerebrospinal fluid. Ninety-seven patients (48 female; mean age, 37 yr; range, 14-79 yr) fulfilled these criteria. We reviewed their clinical, cerebrospinal fluid, and radiologic characteristics. The mean follow-up was 5 years (range, 0-20 yr). The etiologies of rhombencephalitis were as follows: unknown cause (n = 31), multiple sclerosis (n = 28), Behçet disease (n = 10), Listeria monocytogenes infection (n = 9), paraneoplastic syndrome (n = 6) (3 cases associated with anti-Yo antibodies and 3 with anti-Tr antibodies), Epstein-Barr virus (n = 4), tuberculosis (n = 2), pneumococcal infection (n = 2), systemic lupus erythematosus (n = 1), lymphoma (n = 1), Brucella species infection (n = 1), JC virus (n = 1), and relapsing polychondritis (n = 1). Certain clinical, cerebrospinal fluid, and radiologic characteristics that are commonly seen in some of these etiologies can guide us in the first approach to the etiologic diagnosis of rhombencephalitis.
Subject(s)
Encephalitis/epidemiology , Encephalitis/etiology , Rhombencephalon/pathology , Adolescent , Adult , Age Distribution , Aged , Cohort Studies , Combined Modality Therapy , Electroencephalography/methods , Encephalitis/cerebrospinal fluid , Encephalitis/physiopathology , Female , Humans , Incidence , Magnetic Resonance Imaging/methods , Male , Middle Aged , Prognosis , Registries , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Spain/epidemiology , Survival Rate , Young AdultABSTRACT
Introducción Listeria monocytogenes es un bacilo grampositivo, con especial tropismo por el sistema nervioso central (SNC). El absceso cerebral por Listeria es una entidad insuficientemente conocida, a pesar de que representa el 10% de las infecciones del SNC por este microorganismo. Métodos A continuación se presentan 6 pacientes con absceso cerebral por L. monocytogenes que ingresaron de forma consecutiva en el Hospital Universitario de Bellvitge durante los últimos 7 años. Se revisa también la literatura médica de los últimos 40 años hallando 70 pacientes con absceso cerebral por Listeria. Se describen las características epidemiológicas, clínicas, microbiológicas, radiológicas y evolutivas. Resultados El absceso cerebral por Listeria es una entidad de mal pronóstico y con elevada mortalidad. Conclusión Se requiere un elevado índice de sospecha para su detección precoz y tratamiento antibiótico correcto que redunde en una mejor evolución. La sospecha debe fundamentarse en la presencia de fiebre o febrícula junto con focalidad neurológica, sobre todo en pacientes inmunodeprimidos o diabéticos (AU)
Introduction Listeria monocytogenes is a gram-positive bacillus, with special tropism for the central nervous system (CNS). Brain abscess caused by Listeria has not been extensively studied, although it accounts for 10% of CNS infections due to this microorganism. Methods We present 6 patients with Listeria brain abscess consecutively admitted to Bellvitge University Hospital over the last 7 years. A literature review covering 40 years retrieved 70 patients with Listeria brain abscess. The epidemiologic, clinical, microbiological, and radiological findings related to this entity, and the outcome features are described. Results Brain abscess due to Listeria has a poor prognosis and is associated with elevated mortality. Conclusion A high index of suspicion is needed to reach an early diagnosis and establish appropriate antibiotic treatment, which will improve the outcome of this condition. Suspicion is based on the presence of fever and neurological symptoms, particularly in immunodepressed or diabetic patients (AU)
Subject(s)
Humans , Male , Middle Aged , Aged , Brain Abscess/microbiology , Brain Abscess/surgery , Listeriosis/diagnosis , Listeriosis/surgery , Listeria monocytogenes/isolation & purification , Tomography, X-Ray Computed , Magnetic Resonance Imaging , Fatal OutcomeABSTRACT
INTRODUCTION: Listeria monocytogenes is a gram-positive bacillus, with special tropism for the central nervous system (CNS). Brain abscess caused by Listeria has not been extensively studied, although it accounts for 10% of CNS infections due to this microorganism. METHODS: We present 6 patients with Listeria brain abscess consecutively admitted to Bellvitge University Hospital over the last 7 years. A literature review covering 40 years retrieved 70 patients with Listeria brain abscess. The epidemiologic, clinical, microbiological, and radiological findings related to this entity, and the outcome features are described. RESULTS: Brain abscess due to Listeria has a poor prognosis and is associated with elevated mortality. CONCLUSION: A high index of suspicion is needed to reach an early diagnosis and establish appropriate antibiotic treatment, which will improve the outcome of this condition. Suspicion is based on the presence of fever and neurological symptoms, particularly in immunodepressed or diabetic patients.
