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Midbrain infarction: a rare presentation of cryptococcal meningitis
J Kalita1, R Bansal, A Ayagiri
1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Abstract:
A 20-year-old farmer who had headache and fever for 1 month, suddenly developed left hemiplegia, tremor in left arm and titubation followed by deep coma. Cranial CT scan revealed an infarction in right crus of midbrain. His CSF revealed 66 mg/dl protein, 10 lymphocytes/mm3, and 70 mg/dl glucose. CSF was positive for cryptococcal antigen. He improved following i.v. amphotericin 0.5 mg/kg and fluconazole 200 mg daily, continued for 6 and 12 weeks respectively. Infarctions though rare in cryptococcal meningitis should be considered in patients with chronic meningitis with vasculitis.
Insights
Cryptococcal meningitis can cause rare midbrain infarctions, leading to severe neurological deficits. Prompt treatment with antifungal medications is crucial for recovery in these complex cases.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Cryptococcal meningitis is a serious fungal infection of the central nervous system.
- Vasculitis is a known complication of cryptococcal meningitis, potentially leading to ischemic events.
Observation:
- A 20-year-old farmer presented with prolonged headache and fever, followed by acute hemiplegia, tremor, and coma.
- Cranial CT revealed a midbrain infarction.
- Cerebrospinal fluid analysis showed elevated protein, lymphocytic pleocytosis, and positive cryptococcal antigen.
Findings:
- The patient's neurological deficits, including hemiplegia and coma, were attributed to a midbrain infarction.
- Cerebrospinal fluid analysis confirmed cryptococcal meningitis.
- Treatment with intravenous amphotericin B and oral fluconazole led to significant clinical improvement.
Implications:
- This case highlights that midbrain infarctions, though rare, are a potential complication of cryptococcal meningitis.
- The findings underscore the importance of considering vasculitis and ischemic complications in patients with chronic meningitis.
- Early diagnosis and aggressive antifungal therapy are vital for managing cryptococcal meningitis and its neurological sequelae.