Neuromelioidosis in a nutshell-Pattern and Endemicity.

Timely and accurate imaging diagnosis is critical in cases of fever, altered sensorium, seizures, or headaches that do not respond to conventional clinical management. This pictorial essay aims to highlight, through case illustrations, the critical role of imaging in identifying Burkholderia pseudomallei-a rare but significant infectious agent responsible for a characteristic pattern of brain and spinal cord involvement. The condition, known as neuromelioidosis, is endemic in the tropical regions of Southeast Asia and Northern Australia including coastal regions of Tamil Nadu and Karnataka in South India. This review underscores the importance of recognising patterns associated with this disease, with emphasis on the characteristic and specific feature of corticospinal tract involvement. Correct diagnosis is necessary to guide the initiation of targeted antibiotic therapy, which is a critical step in initiating the urgent management required to improve survival outcomes. Furthermore, we provide a discussion of differential diagnoses associated with similar imaging findings, emphasising the need for a nuanced approach to diagnosis and management in such complex cases. By raising awareness of the geographical prevalence and imaging hallmarks of neuromelioidosis, this study aims to enhance clinical decision-making and improve outcomes in affected patients.