Neurolisteriosis mimicking Weber’s syndrome: A rare clinical presentation

Abstract

Neurolisteriosis, an infection of the central nervous system caused by Listeria monocytogenes, can present with a wide variety of clinical signs and symptoms thereby rendering the diagnosis and treatment challenging. This report pertains to a 67-year-old woman with a history of autoimmune haemolytic anaemia on long-term steroid therapy who developed generalized weakness, lethargy, double vision, right third cranial nerve palsy and left hemiparesis. MRI brain revealed multiple brain abscesses in the cerebrum and the brainstem. The cerebrospinal fluid (CSF) culture confirmed the presence of Listeria monocytogenes bacteriae. The patient was treated with high-dose ampicillin and gentamicin leading to significant improvement and near complete neurological recovery at the end of six weeks. While neurolisteriosis presents quite often as a case of meningitis, it can rarely masquerade as stroke, encephalitis and/or cranial nerve palsies. This extremely rare clinical presentation as seen in our patient with multiple brain abscesses, including one in the ventromedial midbrain leading to Weber’s syndrome (crossed hemiplegia), prompted us to report this case.