Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Images in Neurosciences
12 (
2
); 443-444
doi:
10.1055/s-0041-1726648

Listeria Rhombencephalitis

Department of Neurology, Meitra Hospital, Calicut, Kerala, India
Address for correspondence Ashraf V. Valappil, DM Department of Neurology Meitra Hospital, Edakkad PO, Calicut 673004, Kerala India drvvashraf@hotmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Rhombencephalitis is the inflammation of brainstem and cerebellum (hindbrain) and has a variety of potential underlying etiologies that respond variably to treatment, including infections, inflammatory disorders, parainfectious disorders, and paraneoplastic syndromes.1 Listeria is the most common infectious agent causing rhombencephalitis and mostly affects immunocompromised individuals.

A 48-year-old man with background history of multiple myeloma (on chemotherapy with bortezomib, thalidomide, and dexamethasone) was admitted with right hemiplegia and altered mental status. His symptoms began 10 days ago immediately after last course of chemotherapy, with low-grade fever and headache, followed by right hemiparesis. He was hospitalized at another center with a probable diagnosis of acute disseminated encephalomyelitis (ADEM) or herpes encephalitis and was treated with acyclovir and steroids. Subsequently his neurological status gradually worsened and he became quadriparetic and unresponsive. On arrival to our hospital, he was febrile, unresponsive (Glasgow Coma Scale [GCS] of 4/15). He had right third, fourth, and sixth cranial nerve palsy and asymmetric quadriparesis, right side more severely affected. Magnetic resonance imaging (MRI) brain revealed irregular confluent areas of T2 and fluid-attenuated inversion recovery (FLAIR) hyperintensities involving frontal and temporal white matter, both internal capsule, midbrain, pons, and bilateral middle cerebellar peduncle (Fig. 1). Minimal patchy diffusion restriction was noted in bilateral middle cerebellar peduncles and internal capsule (Fig. 2). Patchy contrast enhancement was noted in dorsal midbrain, pons, and part of right internal capsule (Fig. 3). Blood investigations revealed leukocytosis, normal renal function, and liver function tests. Cerebrospinal fluid (CSF) analysis revealed raised protein of 92 mg/dL, normal glucose, and elevated white cell count of 135 cells/mm3 (L68% and P32%). Blood culture and CSF culture grew Listeria monocytogenes confirming the diagnosis of Listeria rhombencephalitis. He was treated with ampicillin injection for 4 weeks and oral cotrimoxazole for 8 weeks, and he recovered well with mild residual quadriparesis.

Fig. 1 MRI T2 FLAIR axial sequences showing (A) bilateral symmetrical hyperintensities involving middle cerebellar peduncle(MCP); (B) hyperintensities involving pons and left temporal white matter; (C) hyperintensities involving midbrain; and (D) hyperintensities involving both internal capsule, left frontal white matter, and corpus callosum. FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.

Fig. 1 MRI T2 FLAIR axial sequences showing (A) bilateral symmetrical hyperintensities involving middle cerebellar peduncle(MCP); (B) hyperintensities involving pons and left temporal white matter; (C) hyperintensities involving midbrain; and (D) hyperintensities involving both internal capsule, left frontal white matter, and corpus callosum. FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.

Fig. 2 MRI (A) diffusion weighted imaging (DWI) showing hyperintensities involving both middle cerebellar peduncle(MCP), (B) corresponding apparent diffusion coefficient (ADC) sequence showing hypointensity of MCP suggestive of diffusion restriction, (C) DWI showing hyperintensities involving both internal capsules, and (D) corresponding ADC slowing corresponding hypointensities involving both internal capsule. MRI, magnetic resonance imaging.

Fig. 2 MRI (A) diffusion weighted imaging (DWI) showing hyperintensities involving both middle cerebellar peduncle(MCP), (B) corresponding apparent diffusion coefficient (ADC) sequence showing hypointensity of MCP suggestive of diffusion restriction, (C) DWI showing hyperintensities involving both internal capsules, and (D) corresponding ADC slowing corresponding hypointensities involving both internal capsule. MRI, magnetic resonance imaging.

Fig. 3 MRI Postcontrast T1 sequence showing patchy contrast enhancement involving (A) pons (B) midbrain (C) right internal capsule. MRI, magnetic resonance imaging.

Fig. 3 MRI Postcontrast T1 sequence showing patchy contrast enhancement involving (A) pons (B) midbrain (C) right internal capsule. MRI, magnetic resonance imaging.

Encephalitis due to L. monocytogenes shows predilection for the brainstem, cerebellar peduncle, and cerebellum as in this patient. Other infrequent sites of involvement include supratentorial white matter, thalamus, internal capsule, and spinal cord.1 2 Most common MRI feature is the T2 hyperintensity followed by contrast enhancement as seen in this patient.1 Other MRI findings include abscess formation, hydrocephalus, edema, and hemorrhages. We noted patchy areas of diffusion restriction indicating areas of necrosis. The regions of restricted diffusion were surrounded by hyperintense signal on T2-weighted images that most likely denoted as edema.2 3 The typical distribution patterns in L. rhombencephalitis may be due to the proliferation and spread of L. monocytogenes along the intracerebral tracts.4 5 In rhombencephalitis, lesions are usually confined to brainstem and cerebellum. Rarely, it can involve internal capsule, frontal lobe, and temporal lobe. This might lead to misdiagnosis as herpes encephalitis or demyelination as in our patient. MRI has a major role in early diagnosis of L. rhombencephalitis, as isolation of L. monocytogenes by culture or PCR may be possible only in up to 50 to 60% of cases.6

Conflict of Interest

None declared.

References

  1. , , , , , , . Clinical presentation and cranial MRI findings of Listeria monocytogenes encephalitis: a literature review of case series. Neurologist. 2018;23(6):198-203.
    [Google Scholar]
  2. , , , , . Diffusion weighted MRI in rhombenceephalits due to Listeria monocytogenes . Acta Radiol. 2007;48:464.
    [Google Scholar]
  3. , , , et al . A rare case of brainstem encephalitis by Listeria monocytogenes with isolated mesencephalic localization. Case report and review. Diagn Microbiol Infect Dis. 2007;58(1):121-123.
    [Google Scholar]
  4. , , , , , . Non-enhancing subcortical white matter lesions in central nervous system listeriosis. Intern Med J. 2015;45(2):228-229.
    [Google Scholar]
  5. , , , . Axonal invasion of Listeria monocytogenes: implications for early diagnosis with magnetic resonance imaging. J Neurol Sci. 2017;373:7-8.
    [Google Scholar]
  6. , , , , , . Two cases of listeria rhombencephalitis. IDCases. 2017;11:22-25.
    [Google Scholar]

Fulltext Views
496

PDF downloads
134
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections