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Updated: Jan 28, 2026
Isolating Central Nervous System Tissues and Associated Meninges for the Downstream Analysis of Immune cells
Published on: May 19, 2020
Cryptococcal meningitis presenting as pseudosubarachnoid hemorrhage
Romy Hoque1, Eduardo Gonzalez-Toledo, Stephen L Jaffe
1Department of Neurology, Louisiana State University School of Medicine-Shreveport, Shreveport, LA 71103, USA. romy.hoque@gmail.com
Abstract:
A 50-year-old man presented with progressive visual loss, headache, and two days of confusion. A computed tomography of his head suggested subarachnoid hemorrhage with accompanying right parietal ischemic infarction. The magnetic resonance image was consistent with right parietal perisulcal pial and superficial cortical inflammation; a subjacent vasogenic edema with a 1 cm diameter abscess was also present. Funduscopy revealed bilateral multifocal choroidal lesions and retinal perivascular sheathing. He was diagnosed with pseudosubarachnoid hemorrhage secondary to cryptococcal meningitis and choroidal microabscesses with retinal inflammation after a cerebrospinal fluid (CSF) examination revealed cryptococcal yeast forms, as well as high titers of CSF cryptococcal antigen, but no CSF red blood cells.
Insights
Cryptococcal meningitis can mimic subarachnoid hemorrhage, presenting with neurological and ocular symptoms. Prompt cerebrospinal fluid analysis is crucial for diagnosing this fungal infection and its associated retinal inflammation.
Area of Science:
- Infectious Diseases
- Neurology
- Ophthalmology
Background:
- Cryptococcal meningitis is a serious fungal infection, particularly in immunocompromised individuals.
- It can present with varied neurological symptoms, sometimes mimicking other conditions.
- Ocular manifestations are common but may be overlooked.
Observation:
- A 50-year-old male presented with headache, confusion, and visual loss.
- Neuroimaging revealed findings suggestive of subarachnoid hemorrhage and ischemic infarction.
- Funduscopy showed bilateral multifocal choroidal lesions and retinal perivascular sheathing.
Findings:
- Cerebrospinal fluid analysis confirmed cryptococcal meningitis with high antigen titers.
- The patient had a 1 cm cerebral abscess and cortical inflammation.
- Ocular findings included choroidal microabscesses and retinal inflammation.
Implications:
- This case highlights the importance of considering cryptococcal meningitis in patients with subarachnoid hemorrhage-like presentations.
- Early diagnosis and treatment are vital to prevent severe neurological and visual complications.
- Integrated neuro-ophthalmic evaluation is essential for comprehensive patient management.
