A case of AIDS associated cryptococcal meningitis with multiple cranial nerve neuropathies

Mohan, Sumit; Ahmed, Salmaan; Alao, Oladipo A.; Schliep, Tjark

doi:10.1016/j.clineuro.2006.01.005

Cited by 21 publications

(13 citation statements)

References 16 publications

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“…Sumit Mohan and colleagues reported a case of cryptococcal meningitis in 2006 with complete loss of vision and hearing as well palsies of the third, sixth and seventh cranial nerves in a sequential manner [4]. Apart from that in our review of the literature we found several references to cases of cryptococcal meningitis with numerous combinations of or isolated second, third, fourth, sixth, seventh and eighth cranial neuropathies.…”

Section: Discussionmentioning

confidence: 87%

“…This causes CSF to accumulate causing high intracranial pressure. Increased intracranial pressure leads to compression of the cranial nerves causing neuropathies [4]. Sixth cranial nerve palsy is very common in the setting of raised intracranial pressure as a false localizing sign and it is well reported in cryptococcal meningitis as well [9].…”

Section: Discussionmentioning

confidence: 99%

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Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report

et al. 2014

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BackgroundCryptococcus neoformans is saprophytic encapsulated yeast. Infection is acquired by inhalation of the organism and could be asymptomatic or limited to the lungs, specially in the immunocompetent host. Cryptococcal meningitis is a serious opportunistic infection among post transplant recipients. Cranial nerve palsies and ophthalmoplegia are well known complications of this disease, but bilateral complete ophthalmoplegia is a very rare presentation.Case PresentationA Sri Lankan young male, who is a post kidney transplant recipient, presented with bilateral complete ophthalmoplegia and subsequently was diagnosed to have cryptococcal meningitis based on Indian ink stain and culture of cerebrospinal fluid (CSF). His magnetic resonance imaging (MRI) showed bilateral multiple nodular lesions in both basal ganglia and thalami. Brainstem imaging was normal.ConclusionsCryptococcal meningitis is a serious fungal infection in post transplant patients. It should be suspected in any immunocompromised patient with fever, headache and focal neurological signs. Bilateral thalamic lesions, inflammation and invasion of the cranial nerves and raised intracranial pressure were thought to be possible mechanisms resulting in bilateral complete ophthalmoplegia in this patient.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report

et al. 2014

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“…In addition to high ICP, CM patients may also show a significant increase in Cryptococcus count in the CSF. Persistent high ICP may be caused by massive proliferation of Cryptococcus in the brain; the large amount of capsular polysaccharides produced blocks the normal circulation of the CSF (Wang et al, 2014;Mohan et al, 2006). Pathogen-directed therapy has proven effective and Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Liu

Peng

Weng

et al. 2019

International Journal of Infectious Diseases

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Background: Ventriculoperitoneal (VP) shunting in cryptococcal meningitis (CM) patients with high intracranial pressure (ICP) has been studied extensively. Methods: A total of 74 CM patients with ICP were identified, including 27 patients with or without ventriculomegaly receiving VP shunting. Results: Through retrospective analysis, there was an obvious decline in ICP as well as Cryptococcus count after VP shunting. Damage to the cranial nerves was improved after the surgery. For those patients receiving VP shunting, there was an obvious decline in ICP as well as Cryptococcus count, with less usage of mannitol. Hydrocephalus or ventriculomegaly was improved, and both the clearance time of Cryptococcus and the hospitalization time were shortened (p < 0.05). The complications of VP shunting were not common. Conclusions: For patients diagnosed with CM and with apparent ICP, VP shunting can be considered regardless of whether there is damage to the cranial nerves or hydrocephaly.

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“…[18] Cranial neuropathies, especially of the lower cranial nerves, affecting one or more cranial nerves (II, VII, VIII, IX, X, XII) occur in isolated cases secondary to basal arachnoiditis or due to hydrocephalus. [19] Cryptococcal meningitis in immunocompetent individuals is more commonly associated with papilloedema, hydrocephalus, focal deficits, seizures and cryptococcomas [20][21][22] [ Figure 4, Table 3]. Differential diagnosis to be considered in a case of suspected cryptococcal meningitis includes tuberculous meningitis and carcinomatous / lymphomatous meningitis.…”

Section: Pathogenesismentioning

confidence: 99%

Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews

et al. 2007

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Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. Among the human immunodeficiency virus (HIV)-seropositive subjects, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection. Current trends are changing due to the marked improvement of quality and length of life produced by highly active antiretroviral therapy (HAART). The introduction of generic HAART in India has resulted in an increase in the number of individuals getting treatment for HIV infection, as the cost of highly active antiretroviral therapy (HAART) has decreased 20- fold. Cryptococcal meningitis occurs in non-HIV patients who are immunodeficient due to diabetes, cancer, solid organ transplants, chemotherapeutic drugs, hematological malignancies etc and rarely in healthy individuals with no obvious predisposing factors. Diagnosis of cryptococcal meningitis is fairly straightforward once the diagnosis is considered in the differential diagnosis of chronic meningitis. Treatment of a patient with cryptococcal infection is a challenge for both the physician and the patient, but rewarding, as many would recover with timely and adequate antifungal therapy.

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A case of AIDS associated cryptococcal meningitis with multiple cranial nerve neuropathies

Cited by 21 publications

References 16 publications

Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report

Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: a case report

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews

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