Brucella meningitis differs from other forms of chronic meningitis because it has a better prognosis; in fact mortality is generally lower, with disease being rarely fatal (<0.5) with proper management, and the cause of death is not always clearly related to brucellosis. On the contrary, patients who suffered from diffuse CNS involvement (severe encephalic or spinal cord disease) had a worse prognosis, with mortality not negligible and frequent sequelae. Meningovascular complications, in particular mycotic aneurysms, ischemic stroke, venous thrombosis, and subarachnoid hemorrhage, are relatively common. The incidence of minor sequelae is high and will increase in case of a delay in treatment; however, only a few patients suffered important limitations in their normal activity [4, 20].

There is still no agreement for choice of antibiotic, dose, and time of the treatment of neurological involvement by Brucella spp. [4]. Monotherapy can cause relapses, from 40 to 80 %; therefore, combined dual or triple combination therapy with doxycycline, rifampicin, trimethoprim-sulfamethoxazole (TMP/SMZ), streptomycin, or ceftriaxone for >2 months is recommended. Ciprofloxacin combined with other antibiotics is as effective as the standard regimen of doxycycline and rifampicin [5, 7, 10].

Cranial nerve palsies compared during acute infection usually resolve completely with therapy, whereas those with chronic CNS infection often have permanent neurological deficit [3, 4, 33]. Some authors suggest that antibiotic treatment has to be continued until improvement of clinical symptoms, glucose normalization in CSF, reduction of leukocytes less than 100 cells/mm³, and the decrease of antibody titers [3].