Presentation
Fever, fatigue, generalized weakness, night sweets, loss of appetite, weight loss, anthalgic gait and bilateral lower limbs weakness.
Patient Data
Mild thickening and marked enhancement of the nerve roots in the conus medullaris and cauda equina extending cranially up to T10 level.
There is evidence for asymmetrical leptomeningeal enhancement involving more the left cerebral hemisphere seen on post-contrast FLAIR images also there is minimal enhancement seen in the left facial nerve.
Minimal erosions were seen on the sacral side of the right sacroiliac joint and both sides of left sacroiliac joint associated with minimal bone marrow edema on both sides of sacroiliac joints.
CSF / CELLS & DIFF
- CSF-RBCs 10 cells/ul
- CSF- WBCs 157cells/ul
- CSF-Neutrophils 23%
- CSF-Lymphocytes 71%
- CSF-Monocytes 6%
CSF
- BACTERIA Not seen.
- OTHERS Not seen.
- GLUCOSE 32.1
- PROTEIN 349
BRUCELLA - SAT
- B. melitensis (TOTAL) 80
- B. melitensis (2ME) 80
- B. abortus (TOTAL) 80
- B. abortus (2ME) 80
EEG:
Electrophysiological evidence of demyelinating polyneuropathy (Guillain-Barré syndrome)
Case Discussion
Guillain-Barré syndrome is an acute polyneuropathy characterized by limb weakness
and mild sensory signs.
Cerebro-spinal fluid analysis typically reveals elevated protein concentrations without
pleocytosis.
Clinical involvement of cranial nerves is common and facial nerves are the
most frequently affected, in approximately 50% of patients; compromise of the bulbar and oculomotor nerves also can be seen.
In our case, the patient was known to have brucellosis with infective contact with his family members. The radiological and lab results show brucellosis infection that is associated with/induced Guillain-Barre syndrome, a known association.
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