•Toreview themost frequentclinical findings and diagnostic criteria of rhombencephalitis.•To showthe main imaging findings of rhombencephalitis.•To analyze the most usual ethiologies and their differential diagnosis.

•Rhombencephalitis refers to inflammatory diseases affecting the hindbrain (brainstem and cerebellum) andhas a wide variety of etiologies.•A proper diagnosis is mandatory in order to avoid potentially severe and life threatening complications.•An accurate imaging differential diagnosisis crucial in the management of these patients.•Certain clinical, CSF, and radiologic characteristics that are usually seen in some of these etiologies could guide us in the first approach to the etiologic diagnosis. •Diffuselesion: multiple or extensive hyper T2 lesion affecting >1/2 brain stem in the axial plane or several zones...

LISTERIA •Complex clinical diagnosis (nonspecific prodrome / few meningeal symptoms), •Exclusion diagnosis (lack of response to empirical treatment). DIAGNOSTIC CRITERIA: •Clinical evidence of acute infection in hindbrain. •No cerebral cortex injury. •Immunocompromised patient •Cardiovascular risk factors (DM, Alcoholism) with suspected bacterial meningism •Increased leucocytes with normal CSF glucose and negative bacteriological studies. •Extensive damage / patchy: fuzzy in brainstem, cerebellar peduncles, cerebellum. •No exophytic component (vs. neoplasm). •T1: hypo-isointense lesion. •T2/FLAIR: hyperintense. •DWI: hyperintense / hypointense on ADC map. •Spectroscopy: allows dd abscess (peak lactate...

•The patient's clinic is of great importance in differential diagnosis of rhombencephalitis.•MRI plays a key role in the acute management of possible infratentorial lesions.•Correlation of MRI findings with other clinical and microbilogical tests is mandatory in order to achieve an accurate final diagnosis.•Listeria rhomboencephalitis is the main frequent cause of infectious rhomboencephalitis•The disappearance of the lesions identified on MRI and clinical improvement in successive evolutionary controls, confirm the rombencephalitis suspicion in the proper context.

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