An atypical case of neuro-Whipple: Clinical presentation, magnetic resonance spectroscopy and follow-up

Caterina Pauletti, Francesco Pujia, Massimo Accorinti, Flavia Pauri, Emanuele Tinelli, Federico Bianco, Cristoforo Morocutti, Francesco Fattapposta

Research output: Contribution to journalArticlepeer-review

Abstract

We report a case of a 53-year-old man with a 2-year history of progressive gait and balance disturbance, supranuclear ophthalmoparesis, mild dysarthria and dysmetria. EMG revealed a lower limb axonal sensory-motor neuropathy, while MR imaging demonstrated a small focal lesion in the right frontal lobe, mild diffuse hyperintensity of the periventricular white matter and diffuse brain atrophy. Magnetic resonance spectroscopy revealed a mild decrease in N-acetyl-aspartate peak and an increase in the choline peak in the small right frontal lesion and within 6 voxels of interest in normal appearing cerebral tissue. According to the clinical picture the diagnosis of WD was made by the positivity of PCR for T. whipplei DNA on CSF. After treatment the patient showed a mild clinical improvement although MR images and laboratory test remained unchanged. The MRS findings suggest that the pathological process of the disease diffusely involves the brain. Despite the absence of gastrointestinal involvement WD should be suspected in all complex and atypical neurological pictures, even in presence of peripheral involvement, in order to be able to start treatment promptly.

Original languageEnglish
Pages (from-to)97-100
Number of pages4
JournalJournal of the Neurological Sciences
Volume297
Issue number1-2
DOIs
Publication statusPublished - Oct 15 2010

Keywords

  • Central nervous system infection
  • Magnetic resonance spectroscopy
  • Neuro-Whipple
  • Peripheral neuropathy
  • Tropheryma whipplei

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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