Neurobrucellosis occurs in 5–10% of cases of brucellosis and affects the central or peripheral nervous system. This may lead to a variety of imaging abnormalities that mimic other neurologic diseases.

To describe MRI brain finding of ventriculitis secondary to neurobrucellosis.   

37 y/o goat farmer without significant past medical history who was admitted with fever, abdominal pain, vomiting, and unsteady gait for 10 days. Five months prior to admission he noticed low grade fever, generalized body ache, joint pain, and 10 Kgs weight loss. He admits caring for sick goats during parturition and drinking unpasteurized milk.

Physical exam showed normal cranial nerve exam except for scanning speech. Normal strength and symmetric reflexes of 2/4. Symmetric and intact sensation for all modalities. Down-going toes. Mild intension tremor with normal finger-nose and heel-shin. Wide-based unsteady gait.

CSF showed high WBC (733), 75% lymphocytes, elevate protein (LP 63 mg/dL), and low glucose (CSF 32 mg/dL- serum 117 mg/dL).

Brucella serology was high (1:320). Negative Treponema pallidum Antibodies and TB extensive work up including QuantiFERON-TB gold plus, CSF TB PCR, acid fast bacilli stain and culture. Negative CSF fungal stain and culture. Negative CSF virology PCR.

Positive oligoclonal bands in CSF.

MRI brain showed ventricular enlargement consistent with mild hydrocephalus. Ependymal enhancement consistent with ventriculitis, and meningeal enhancement post gadolinium injection.

MRI spine showed meningeal enhancement.

There was significant improvement clinically and radiologically post treatment with rifampicin and doxycycline for 6 months and ceftriaxone for 6 weeks.