An Uncommon Presentation of Cryptococcal Meningoencephalitis

Abstract

Cryptococcal meningoencephalitis (CM) remains a common cause of central nervous system infections. Patients usually present with headache, fever, malaise, and altered mental status over several weeks. Signs are often absent, but they may include meningism, papilledema, cranial nerve palsies, and depressed level of consciousness. Individuals with CM can occasionally present with small vessel vasculitis causing cerebral lesions. The literature regarding patterns of cerebrovascular injury in CM is scarce. We describe a case of CM in which an unusual presentation was observed: transient focal neurological symptoms initially with absence of fever that led to a misleading primary diagnosis of transient ischemic attack. Since neurological symptoms may be a manifestation of a cryptococcal infection, it is necessary to have a high degree of suspicion for this pathology in the presence of focal neurological deficits, even in patients with vascular risk factors, requiring a thorough etiological investigation.

Clinical and pathological characterization of Central Nervous System cryptococcosis in an experimental mouse model of stereotaxic intracerebral infection

“…The latter group displays numerous cryptococci in the subarachnoid space post-mortem, associated with raised intracranial pressure (ICP) and hydrocephalus [33], CSF fungal burden, and GXM accumulation, which are all associated with mortality [34]. In addition, blood vessel occlusion and damage are frequently associated with systemic infection, given that individuals with CME develop aneurisms or subarachnoid hemorrhage [35]. In fact, there are instances where CME has been associated with ischemic stroke with vasculitis in HIV + [36] and HIVindividuals [37].…”

Infratentorial Cryptococcus neoformans meningoencephalitis with cerebellar infarction: A rare case report

“…CM patients usually present with headache, fever, malaise, and altered mental status within several weeks. Clinical manifestations may include meningism, papilledema, cranial nerve palsies, and depressed level of consciousness [ 5 ]. According to the analysis of MRI examination results in 110 CM patients, including local lesions (24.5%), multi-site lesions (30%), abnormal meningeal enhancement (12.7%) and hydrocephalus (12.7%) and no lesions (17.3%), the most common cerebral area affected by CM was frontal lobe among different combination of these MRI features [ 1 ].…”