Isolated rhombencephalitis with good clinical recovery

Abstract

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).Idiopathic inflammatory central nervous system disease and neuroinfection are the major differential diagnoses for isolated rhombencephalitis, especially Listeria