Cryptococcal Meningitis Causing Refractory Hemichorea-Hemiballismus Treated With Pallidotomy

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Cryptococcal meningitis can cause neurological complications.
• Choreiform movements and hemiballismus are rare but severe symptoms.

Observation:

• A 31-year-old immunocompetent male presented with altered mental status, agitation, and subsequent choreiform movements/hemiballismus.
• The patient was diagnosed with cryptococcal meningitis.
• Pharmacological treatments for chorea were ineffective.

Findings:

• Successful unilateral pallidotomy was performed using stereotactic methods targeting the posterior-ventral pallidum.
• The patient experienced dramatic improvement in choreiform movements within 48 hours post-surgery.

Implications:

• Pallidotomy is a viable surgical option for refractory choreiform movements secondary to cryptococcal meningitis.
• This case highlights the importance of considering surgical interventions for severe movement disorders unresponsive to medical management.
• Stereotactic pallidotomy offers a potential solution for debilitating chorea in infectious neurological conditions.