Analysis of seven cases of neurobrucellosis manifested as cerebrovascular diseases / 中华神经科杂志

ABSTRACT

Objective To analyze the clinical features of neurobrucellosis manifested as cerebrovascular diseases and explore the possible pathogenesis.Methods Cases of neurobrucellosis presenting as cerebrovascular diseases in Peking Union Medical College Hospital from January 2007 to February 2018 were analyzed retrospectively.The demographic information,epidemiological history,routine and etiology tests of blood and cerebrospinal fluid,imaging (magnetic resonance imaging + diffusion weighted imaging,magnetic resonance angiography/head and neck computed tomography angiography),echocardiography,treatment and prognosis of the above patients were collected.The possible mechanism of neurobrucellosis with cerebrovascular diseases was analyzed according to clinical manifestations and imaging characteristics.Results Totally,31 cases of neurobrucellosis were diagnosed,of which seven cases were mainly presented as cerebrovascular diseases (three cases as the first symptoms),accounting for 23％ of neurobrucellosis.There were three cases of cerebral infarction,one case of cerebral infarction accompanied with cerebral hemorrhage,one case of transient ischemic attacks (TIA),two cases of imaging abnormalities related to cerebral small vessel disease.Three patients were discharged voluntarily and four patients were treated with minocycline/doxycycline,rifampicin and ceftriaxone.The prognosis of the treatedcases was good.Conclusions Neurobrucellosis may be presented as TIA,cerebral infarction,cerebral hemorrhage or cerebral small vessel disease related imaging features.For cerebrovascular diseases with systemic nonspecific symptoms such as hearing loss and fatigue,it is necessary to differentiate Brucella infection.Vasospasm,vasculitis and infection-induced arteriosclerotic infarction may be the possible mechanism of stroke in these patients.