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JAMA Neurology Clinical Challenge
January 10, 2022

A Woman With Eosinophilic Brainstem Meningoencephalitis

Author Affiliations
  • 1Department of Neurology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
JAMA Neurol. 2022;79(2):198-199. doi:10.1001/jamaneurol.2021.4861

A previously healthy 25-year-old woman presented with headache, dysarthria, double vision, and dizziness for 1 week. She denied any history of fever, head trauma, vomiting, diarrhea, abdominal pain, or cough. She had traveled to northeastern Brazil 2 months before the onset of the neurological symptoms.

On examination, she had a mild right-side hemiparesis with hyperreflexia and hemiataxia. She could walk unassisted but presented with a broad base. There were no meningeal signs. She did not present with hepatosplenomegaly of lymphadenopathy. Her cranial magnetic resonance imaging showed a T2-weighted fluid-attenuated inversion recovery hyperintense lesion with heterogeneous gadolinium enhancement in the pons (Figure). There were no signs of diffusion restriction on diffusion-weighted imaging or hemorrhages on susceptibility-weighted imaging.

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