The Cerebellar Leptomeningeal Enhancement Associated with Cryptococcal Meningitis

Abstract

A 71-year-old male construction worker without human immunodeficiency virus had a headache. He showed meningeal signs and ataxia. His cerebrospinal fluid showed a cell count of 335/μL (60% polymorphonuclear leukocytes) and protein level of 171 mg/dL, with a glucose level of <10 mg/dL. Indian ink staining revealed fungus bodies (Picture 1). Brain magnetic resonance imaging showed enhance-

Cryptococal Meningitis Presenting as Acute Cerebellar Syndrome

“…[ 6 ] A similar MRI picture has been reported from Japan in a 71-year-old apparently immunocompetent male with cryptococcal meningitis. [ 7 ] The lack of fever, neck stiffness, severe headache, initial CSF negativity for cryptococcal infection, and retro-negative status of the patient made further delay in the diagnosis. In addition, this case highlights the need for repeat CSF testing, when the patient symptoms persist during empirical treatment with ATT in patients with subacute or chronic meningitis.…”