Cryptococcosis Presenting as Cerebrovascular Disease.

Area of Science:

• Neurology
• Infectious Diseases
• Vascular Neurology

Background:

• Infection significantly impacts cerebrovascular disease, with direct and indirect roles in stroke pathogenesis.
• Prompt diagnosis and management of infection-related strokes are critical to prevent severe neurological deficits.
• Cryptococcal meningoencephalitis is a serious central nervous system infection that can manifest with diverse clinical and radiographic features.

Observation:

• Two cases of cryptococcal meningoencephalitis presenting with atypical cerebral infarction are described.
• Patients presented with varied symptoms including cognitive changes, seizures, and stroke-like symptoms, despite differing medical histories.
• Both patients developed multiple cerebral infarcts across various vascular territories, confirmed by histologic and radiologic findings.

Findings:

• Histologic and radiologic findings were consistent with central nervous system cryptococcosis in both patients.
• Diagnosis of cryptococcal meningoencephalitis was established, and patients were treated with amphotericin B and flucytosine.
• Both patients showed significant clinical improvement and neared their neurologic baseline before discharge to rehabilitation.

Implications:

• Understanding the varied presentation of cryptococcal CNS infections is vital for timely diagnosis.
• Infection-mediated cerebral infarcts should be considered in patients presenting with stroke, irrespective of traditional risk factors.
• Early initiation of antimicrobial therapy for CNS infections can minimize adverse neurological outcomes and improve patient prognosis.