Clinical Presentation and Cranial MRI Findings of Listeria monocytogenes Encephalitis

Abstract

Background: Listeria monocytogenes–associated encephalitis is a severe clinical condition that can also be seen in immunocompetent patients. Clinical manifestation and radiologic features of this entity need to be elaborated. Review Summary: We searched the medical literature during the period spanning from 1991 to 2017 using the keyword “listeria AND (abscess OR brainstem OR encephalit* OR magnetic* OR imaging*).” We included in the review well-documented adult cases with a definitive diagnosis and having magnetic resonance imaging data. Confusion, hemiparesis, cerebellar ataxia, facial paralysis, and gait disturbance were the most frequent findings, detected in >30% of patients during admission. The high rate of facial paralysis was of particular interest. T2 hyperintensity (80/82), contrast enhancement (60/82), and ring-enhancing lesions, which are considered as brain abscess, were found in 46/82 patients. The mortality and neurological sequel rates were 20% and 68%, respectively. Conclusions: Listeria encephalitis is a severe disease and should be remembered in cases admitted with symptoms related to the brainstem and cranial nerve dysfunction. Cranial magnetic resonance imaging with brainstem and cerebellum involvements and contrast enhancement with or without abscess are particularly suggestive of the listeria-related infection.

Infekcinio encefalito diagnostika ir gydymas imunosupresinių būklių metu: klinikinio atvejo pristatymas ir literatūros apžvalga

“…Nau jausiais li te ra tû ros duo me ni mis, net 52 % li go niø, ku riems diag no zuo tas L. monocytogenes en ce fa li tas, bu vo imu nosup re suo ti, o daþ niau sia imu no sup re si jos prie þas tis -il galai kis kor ti kos te roi dø var to ji mas (67 %). Daþ niau si neu rolo gi niai pa þei di mo simp to mai, at vy kus á li go ni nae, bu vo: he mi pa re zë (40 %), sme ge në li në atak si ja (39 %), n. facialis pa ra ly þius (37 %), ei se nos su tri ki mai (32 %) ir nis tagmas (28 %) [39]. L. monocytogenes su kel to en ce fa li to metu lik vo re daþ niau siai ran da mas pa di dë jaes leu ko ci tø skaièius (me dia na -310 làs te liø/mm 3 ), do mi nuo jant lim fo citams, pa di dë jaes bal ty mo kie kis (me dia na -2,3 g/l) ir su maþë ju si gliu ko zës kon cen tra ci ja (75 % at ve jø) [4].…”

“…Gal vos sme ge nø MRT vaiz duo se daþ niau siai nu sta to mi hi pe rinten si niai þi di niai T2 se ko je (81 %), kon tras ti nës me dþiagos kau pi mas (60 %) bei þi di niø kon tras to kau pi mas þie du (46 %). Daþ niau sia pa þei di mø lo ka li za ci ja -sme ge nø kamie nas (55 %), su pra ten to ri në bal to ji me dþia ga (25 %) ir sme ge në liø pus ru tu liai (20 %) [39]. En ce fa li to diag no zë pa tvir ti na ma nu sta èius L. monocytogenes au gi mà lik vo ro pa së ly je [8].…”

Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess

“…It could lead to a high rate of morbidity and mortality, especially in consideration of the unspecific prodromal symptoms (fever, dizziness, nausea, vomiting) and more rarely signs of meningeal irritation. 1,2 The most common CNS manifestation is represented by meningitis, since epithelium of the choroid plexus enables LM to gain access to CNS. However, less commonly, it may reach the brain parenchyma via the cerebral capillary endothelium resulting in cerebritis and rhombencephalitis which may lead to brain abscess formation.…”

Listeria Rhombencephalitis

“…Other infrequent sites of involvement include supratentorial white matter, thalamus, internal capsule, and spinal cord. 1,2 Most common MRI feature is J Neurosci Rural Pract 2021;12:443-444. Images in Neuroscience Ashraf, Salam the T2 hyperintensity followed by contrast enhancement as seen in this patient.…”

“…Images in Neuroscience Ashraf, Salam the T2 hyperintensity followed by contrast enhancement as seen in this patient. 1 Other MRI findings include abscess formation, hydrocephalus, edema, and hemorrhages. We noted patchy areas of diffusion restriction indicating areas of necrosis.…”