Neurolisteriosis presenting as recurrent transient ischemic attacks

An elderly man experienced recurrent transient episodes of right arm weakne ss and expressive aphasia He was initially treated with aspirin and then wi th coumadin. Thirteen days after initial presentation, he became febrile an d had signs of meningitis. The illness progressed relentlessly to death 9 w eeks after admission to the hospital. Necropsy showed prominent meningitis with vasculitis extending into the left frontal lobe. Polymerase chain reac tion identified the organism as Listeria monocytogenes.