CLINICAL, EPIDEMIOLOGICAL, LABORATORY an‎d IMAGING ASPECTS OF BRUCELLOSIS WITH an‎d WITHOUT NEUROLOGICAL INVOLVEMEN

Brucellosis is an endemic infectious disease in our country. Neurobrucellosis occurs in 5 to 10% of cases, and can present at any stage of acute or chronic phases of the disease. This study was undertaken to evaluate clinical, epidemiological and paraclinical aspects of brucellosis with and without neurological manifestations. Data of 30 patients, 15 cases with nervous system involvement (neurobrucellosis) and 15 cases without neurological complication (brucellosis) were collected and analysed. Constitutional manifestations of the disease including: fever, headache, fatigue, anorexia, diaphoresis, arthralgia and low back pains were detected with nearly the same frequencies in both groups. Exceptions were headache which was more common in patients with neurobrucellosis (73% vs. 33%) and arthralgia which was detected more frequently in cases with brucellosis than neurobrucellosis (53% vs. 13%). Signs and symptoms of meningeal irritation and disturbances of consciousness were the most common manifestations in cases with neurobrullosis, which had been detected in 60% and 46.7% of cases respectively. Less common neurological presentations, in decreasing order of frequency were ophthalmoplegia, papilledema and seizures (each in 26.7% of cases), spastic weakness of limbs (20%), hearing loss (13.3%) and spinal epidural abscess (6.7%). Two of our patients with neurobrucellosis had negative serum and CSF agglutinin test, in whom diagnosis was made by blood and CSF cultures. In patients with neurobrucellosis, MRI of brain and spinal cord showed abnormalities in 5/15(33.3%) of cases, including decreased lateral ventricular volume due to brain swelling (2/15), hydrocephalus with periventricular edema and meningeal enhancement in posterior fossa (1/15), multiple hypodense periventricular lesions, ischemic or demyelinative in nature (1/15) and spinal epidural abscess (1/15).