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MR angiography of large-vessel intracranial stenosis after cryptococcal meningitis
Abstract:
We present a case of cryptococcal meningoencephalitis producing narrowing of both middle cerebral arteries on MRI/MRA, described in a 56-year-old man with a history of Wegener's granulomatosis. Diagnosis was based on the presence of cryptococcal antigen in serum and CSF. Imaging performed seven months after initial presentation demonstrated thickened enhancing leptomeninges with focal inflammatory masses in the Sylvian fissures. To our knowledge, this striking appearance has not been previously demonstrated simultaneously on MRI/MRA.
Insights
This case study highlights cryptococcal meningoencephalitis causing middle cerebral artery narrowing in a patient with Wegener's granulomatosis. The study details unique MRI/MRA findings of leptomeningeal enhancement and inflammatory masses.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cryptococcal meningoencephalitis is a serious fungal infection of the brain and meninges.
- Wegener's granulomatosis (now Granulomatosis with Polyangiitis) is a rare autoimmune disorder affecting blood vessels.
Observation:
- A 56-year-old male with a history of Wegener's granulomatosis presented with symptoms of meningoencephalitis.
- Cerebrospinal fluid (CSF) and serum tests confirmed the presence of cryptococcal antigen.
- Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) revealed narrowing of both middle cerebral arteries.
Findings:
- Imaging demonstrated thickened, enhancing leptomeninges.
- Focal inflammatory masses were observed within the Sylvian fissures.
- The combination of cryptococcal meningoencephalitis and bilateral middle cerebral artery narrowing on MRI/MRA is a novel observation.
Implications:
- This case expands the understanding of potential vascular complications in cryptococcal meningoencephalitis.
- The findings suggest a need for thorough neuroimaging in immunocompromised patients with cryptococcal infections.
- Further research may elucidate the mechanisms linking fungal infections to arterial changes.
