Neurobrucellosis: A Narrative Review

Background: Neurobrucellosis is a rare but serious complication of systemic Brucella infection, occurring in approximately 3–15% of cases and accounting for about 0.5% of all community-acquired central nervous system (CNS) infections. Although uncommon, it poses significant diagnostic challenges and carries the risk of long-term neurological sequelae. Objective: This review provides a comprehensive overview of the epidemiology, pathogenesis, clinical manifestations, diagnostic strategies, and management of neurobrucellosis, with an emphasis on current evidence and diagnostic difficulties. Methods: A thorough literature review was conducted, incorporating clinical studies, case series, and reviews addressing various aspects of neurobrucellosis. Findings: Neurobrucellosis can affect both the central and peripheral nervous systems. Central involvement includes meningitis, meningoencephalitis, cranial neuropathies—most commonly affecting the eighth cranial nerve—white matter lesions, vascular complications, and spinal cord syndromes such as arachnoiditis or transverse myelitis. Peripheral nervous system involvement, though less frequent, may present as polyradiculoneuropathies or mimic Guillain–Barré syndrome. Diagnosis is based on clinical suspicion supported by cerebrospinal fluid analysis, serologic testing, neuroimaging, and molecular methods such as PCR. MRI is the imaging modality of choice, although up to 60% of cases may show no abnormalities. Treatment typically consists of a prolonged combination antibiotic regimen tailored to disease severity and localization. Conclusion: Neurobrucellosis requires early recognition and prompt, appropriate antibiotic therapy to reduce the risk of permanent neurological damage. A high index of suspicion is essential, particularly in endemic regions or in patients with unexplained neurological symptoms and epidemiologic risk factors. Keywords: Neurobrucellosis, meningitis, meningoencephalitis, cranial neuropathy