Page 83 - BH-2-2

Brain & Heart

CASE REPORT
Approaching an undetermined diagnosis in the

aftermath of rhombencephalitis: A case report

Debabrata Chakraborty*
Department of Neurology, Apollo Multispeciality Hospital, Kolkata, West Bengal, India

Abstract

A 49-year-old male patient manifested acute onset increased imbalance, quadriparesis,
and speech impairment 1 month after undergoing ventricular-peritoneal shunt for
normal pressure hydrocephalus (although magnetic resonance imaging [MRI] of the
brain with contrast was otherwise normal), which showed improvement afterward.
He had hypercalcemia and elevated erythrocyte sedimentation rate. Repeat brain MRI
revealed pachymeningitis coupled with rhombencephalitis, while cerebrospinal fluid
study unveiled only increased protein level without evidence of active infection. Given
these findings, neurosarcoidosis was preliminarily considered a plausible cause of the
recent clinical manifestations, and the patient was prescribed methylprednisolone, which
led to significant improvement. However, the steroid treatment was discontinued on the
revelation that the patient grappled with severe sepsis. Despite an initial improvement
following a post-management of sepsis, his condition deteriorated, and he became
lost to follow-up after 4 months of initial presentation. An infective etiology was ruled
out since his condition improved with steroid. Precluding vasculitis or demyelinating
disorder left the physicians with primary central nervous system (CNS) lymphoma
or sarcoidosis as a proper diagnosis based on the fact that the patient experienced
*Corresponding author: deterioration when steroid was excluded from the treatment regimen. This case study
Debabrata Chakraborty
(drdchakraborty1980@gmail.com) portrays a need to conduct a more specific and elaborate investigation, driven by a
strong perception to both primary CNS lymphoma and sarcoidosis, to optimize clinical
Citation: Chakraborty D.
Approaching an undetermined diagnosis, which facilitates the formulation of an appropriate treatment regimen.
diagnosis in the aftermath of
rhombencephalitis: A case report.
Brain & Heart. 2024;2(2):2133. Keywords: Neurosarcoidosis; Rhombencephalitis; Hydrocephalus; Primary central
doi: 10.36922/bh.2133 nervous system lymphoma
Received: October 27, 2023
Accepted: January 26, 2024
Published Online: April 23, 2024 1. Introduction
Copyright: © 2024 Author(s). In some neurological diseases, it is difficult to reach a definite diagnosis within a
This is an Open-Access article short period of time when patient is experiencing rapid deterioration. Under many
distributed under the terms of the
Creative Commons Attribution circumstances, physicians need to leverage information gleaned from clinical findings,
License, permitting distribution, ancillary tests, and treatment response to make the final diagnosis. Very often, physicians
and reproduction in any medium, prioritize saving patient’s life based on any signs and symptoms presented to them when
provided the original work is
properly cited. a definite diagnosis has yet to be finalized; simultaneously, more diagnosis-oriented
investigations are conducted.
Publisher’s Note: AccScience
Publishing remains neutral with It is a challenging endeavor to diagnose neurosarcoidosis due to the difficulty to
regard to jurisdictional claims in
published maps and institutional conduct a tissue biopsy. Even so, biopsy specimens do not always provide conclusive
affiliations. findings to aid the diagnostic process. In this case study, the patient was given a steroid

Volume 2 Issue 2 (2024) 1 doi: 10.36922/bh.2133