Clinical Spectrum, Diagnostic Characteristics, and Treatment Outcomes of Neurobrucellosis: A Narrative Synthesis of Individual Patient Data From Global Literature

Neurobrucellosis is a rare and serious complication of brucellosis that can present with a broad spectrum of neurological symptoms, making early detection challenging. The objective of this study was to comprehensively analyze data on neurobrucellosis to characterize its clinical manifestations, diagnostic approaches, and management strategies. This narrative review consolidates the available literature on all cases of neurobrucellosis published between inception and November 30, 2025, using the PubMed Central and Google Scholar databases. The data were stratified using predefined keyword combinations and Boolean operators. All case reports, case series, and original articles with confirmed cases of neurobrucellosis with intracranial involvement were included. After detailed scrutiny of the existing literature, a total of 23 articles were identified with data on 34 patients. Among the 34 patients, 22 (64.70%) were males, and 12 (35.29%) were females. The mean age was 35.7 ± 19.45 years. The most common presenting symptoms were headache in 23 (67.64%), fever in 16 (47.05%), and vomiting in 11 (32.35%) patients. On neurological examination, generalized weakness was present in eight (23.50%) patients, seizures in eight (23.50%) patients, and hearing loss in eight (23.50%) patients. The preferred imaging modality was MRI, which demonstrated hypointense multiloculated lesions on T1-weighted images in 11 (32.35%) patients and hyperintense lesions on T2-weighted images in eight (23.52%) patients. The most frequently involved brain region was the frontal lobe in 11 (32.35%) patients. Serological testing was confirmatory for diagnosis in 30 (88.23%) patients, with positivity on the serum agglutination test. CSF analysis showed elevated protein in 13 (38.23%) patients, leukocytosis in 10 (29.41%) patients, and culture positivity in four (11.76%) patients. The most common species was Brucella melitensis, which was identified in six (17.64%) patients. The average time to diagnosis was 8.83 ± 6.80 months. Approximately 21 (61.76%) patients received medical therapy alone, and 12 (35.29%) underwent combined medical and surgical management. Neurobrucellosis often presents with nonspecific prodromal symptoms, making early diagnosis challenging. Imaging commonly reveals frontal lobe involvement with characteristic hypointense multiloculated lesions on T1-weighted MRI and hyperintense signals on T2-weighted MRI. Diagnosis relies on positive serological testing, particularly serum agglutination tests, in conjunction with clinical and radiological findings. Optimal outcomes require a tailored multimodal management approach incorporating appropriate antimicrobial therapy with surgical intervention when indicated.