Magnetic Resonance Imaging Findings of Pediatric Neurobrucellosis

Brucellosis is an endemic disease often observed in the Mediterranean and Middle East regions. Systemic brucellosis is the most frequent clinical form of this infection; however, hematogenic spread may result in the focal form of the disease. Neurobrucellosis is a rare disease seen in 0, 5-25 % of the adults with systemic brucellosis. 0,8 % of the children affected by systemic brucellosis are reported to have neurological complications. A 16 year old female applied with the complaints of headache, vomiting, bilateral hip and knee pain, and inability to walk. Physical and laboratory examination, brain computed tomography (CT) brain and cervical spinal MRI were carried out as well as the magnetic resonance spectroscopy (MRS) of the lesion areas in the brain. On MRI hydrocephaly in 3rd, 4th and lateral ventricles, atrophic dilatation in bilateral hemispheric cortical sulcuses were seen. On T2W and FLAIR images, hyperintense focal nodular lesions not accompanied by pathological contrast enhancement were detected on parietal subcortical white matter and the periventricular deep white matter. Dural thickening and contrast enhancement on the bilateral parietal region were observed. On cervical spinal MRI, leptomeningeal enhancing was at the level of C1-C7. On MRS applied to lesions in brain (TE 136 and 31 ms), lactate peak at 1.3 ppm was observed. In the differential diagnosis of central nervous system diseases in children living in endemic regions, neurobrucellosis should be kept in mind, though observed rarely. In these cases, the neurological system involvement that cannot be demonstrated via CT, can be shown with MRI effectively.