White Matter Spreading MRI Pattern of Listeria monocytogenes

A 45-year-old woman with a history of chronic lymphocytic leukemia treated by ibrutinib presented with progressive-onset left-sided body deficit, diplopia, and fever. A CT of the head showed right pericentral nodular hemorrhagic lesions with perilesional edema. Brain MRI (Figures 1 and 2) revealed nodular hemorrhagic lesions with perilesional edema, ring enhancement, and central diffusion restriction mainly distributed along the right corticospinal tract. Lumbar puncture detected neutrophilic meningitis, and blood cultures revealed Listeria monocytogenes.