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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(10): 757
DOI: 10.1590/0004-282X20170133
Images in Neurology

Isolated rhombencephalitis with good clinical recovery

Rombencefalite isolada com boa recuperação clínica
Bruna Klein da Costa
1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia, Porto Alegre RS, Brasil
,
Bruno Samuel Fraiman de Oliveira
1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia, Porto Alegre RS, Brasil
,
Jefferson Becker
1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia, Porto Alegre RS, Brasil
,
Douglas Kazutoshi Sato
1   Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Neurologia, Porto Alegre RS, Brasil
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
3   Tohoku University Graduate School of Medicine, Department of Multiple Sclerosis Therapeutics, Sendai, Japan
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A 20-year-old, previously-healthy woman presented with progressive tetraparesis, multiple cranial nerve involvement and pseudobulbar affect over three weeks. Brain MRI revealed a unique edematous brainstem lesion with peripheral gadolinium enhancement ([Figure 1]). She was treated with long-term antibiotics (21 days of ampicillin and sulfamethoxazole/trimethoprim) and high-dose intravenous corticosteroids. Oral prednisone was slowly tapered with full clinical recovery and resolution of the lesion after five months ([Figure 2]).

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Figure 1 Brain MRI. (A) Axial T2 weighted and fluid-attenuated inversion recovery (FLAIR) (B) images demonstrating a hyperintense brainstem lesion with increased signal in diffusion-weighted image (DWI) (C). Coronal T1 weighted post-gadolinium image (D) show mild peripheral enhancement.
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Figure 2 Brain MRI after treatment. Axial T2 weighted (A), FLAIR (B) and DWI (C) sequences demonstrate almost complete resolution of the brainstem lesion. Axial T2 weighted image shows discrete hyperintense lesion (A) without gadolinium enhancement (D).

Idiopathic inflammatory central nervous system disease and neuroinfection are the major differential diagnoses for isolated rhombencephalitis, especially Listeria[1]. Despite the severity, patients may have full recovery if managed properly.


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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Jubelt B, Mihai C, Li TM, Veerapaneni P. Rhombencephalitis / brainstem encephalitis. Curr Neurol Neurosci Rep. 2011;11(6):543-52. https://doi.org/10.1007/s11910-011-0228-5

Address for correspondence

Douglas Kazutoshi Sato
Serviço de Neurologia do Hospital São Lucas / PUCRS; Av. Ipiranga, 6690; 90610-000 Porto Alegre RS
Brasil   

Publication History

Received: 18 December 2016

Accepted: 18 July 2017

Article published online:
04 September 2023

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