A rare cause of seizures: brucellar brain abscess.

Brucellosis is one of the most common zoonotic infection worldwide and endemic in Turkey. It constitutes an important public health problem, especially in rural areas. Brucellosis primarily occurs in animals and it is transmitted to humans by direct contact with infected animals or ingestion of unpasteurized milk and milk products.1 Brucellosis is a multisystem disease and the clinical features of brucellosis vary greatly. Neurobrucellosis is a rare complication in childhood which can be detected in 2–7 percent of cases. The most common clinical forms of neurobrucellosis are meningitis, encephalitis, and myelitis while brucellar brain abscess is extremely rare.2 Here, an eight-yearold girl with afebrile seizures due to brucellar brain abscess is presented to emphasize different clinical manifestations of brucellosis in endemic areas. An eight-year-old girl was admitted to our hospital with complaints of vomiting and afebrile seizures. Her history revealed malaise, loss of appetite, and recurrent afebrile generalized tonic seizures lasting for 8–10 min in the past month. Her medical history was unremarkable with no history of trauma. On admission, she had no fever, nor any neurological deficits and the systemic examination was unremarkable except for a systolic murmur. Laboratory tests included complete blood count and blood chemistry within normal limits except for an elevated C-reactive protein (CRP) of 74 mg/L. Electrocardiography (ECG) and echocardiography were normal. The awake and asleep EEG revealed slowing of background rhythm over the left parieto-occipital area with no epileptiform discharges. She had two episodes of afebrile generalized tonic seizures at the time of hospitalization and phenytoin was started. Cranial magnetic resonance imaging (MRI) showed a multiloculated lesion 50 mm × 40 mm in size, hypointense on T1 and hyperintense on both T2 and fluid-attenuated inversion recovery (FLAIR) images at the left parieto-occipital region with peripheral edema. Contrast enhancement was also suggestive of an abscess formation (Fig. 1). Lumbar puncture was not performed because of the large mass compatible with brain abscess and the surrounding extensive edema. Ceftriaxone, metronidazole, and mannitol were added. The case underwent burr hole drainage r brain abscess