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An Uncommon Presentation of Cryptococcal Meningoencephalitis
Isabel Freitas1, Tatiana Salazar2, Pedro Rodrigues3
1Internal Medicine, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, PRT.
Abstract:
Cryptococcal meningoencephalitis (CM) remains a common cause of central nervous system infections. Patients usually present with headache, fever, malaise, and altered mental status over several weeks. Signs are often absent, but they may include meningism, papilledema, cranial nerve palsies, and depressed level of consciousness. Individuals with CM can occasionally present with small vessel vasculitis causing cerebral lesions. The literature regarding patterns of cerebrovascular injury in CM is scarce. We describe a case of CM in which an unusual presentation was observed: transient focal neurological symptoms initially with absence of fever that led to a misleading primary diagnosis of transient ischemic attack. Since neurological symptoms may be a manifestation of a cryptococcal infection, it is necessary to have a high degree of suspicion for this pathology in the presence of focal neurological deficits, even in patients with vascular risk factors, requiring a thorough etiological investigation.
Insights
Cryptococcal meningoencephalitis (CM) can mimic stroke with focal neurological deficits. Early suspicion is crucial for accurate diagnosis and timely treatment of this serious CNS infection.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroscience
Background:
- Cryptococcal meningoencephalitis (CM) is a significant cause of central nervous system infections.
- Typical symptoms include headache, fever, and altered mental status, developing over weeks.
- Neurological signs may be subtle or absent, but can include meningism and cranial nerve palsies.
Observation:
- CM can present with small vessel vasculitis leading to cerebral lesions.
- Cerebrovascular injury patterns in CM are not well-documented in existing literature.
- A case demonstrated transient focal neurological symptoms mimicking a transient ischemic attack, initially without fever.
Findings:
- The case highlights an unusual presentation of CM with initial focal neurological deficits.
- The absence of fever and presence of vascular risk factors can lead to misdiagnosis.
- Prompt etiological investigation is essential when neurological symptoms suggest CM.
Implications:
- Neurological symptoms, including focal deficits, warrant high suspicion for cryptococcal infection.
- Consider CM in patients with focal neurological deficits, even with vascular risk factors.
- This case underscores the need for thorough etiological workup to avoid diagnostic delays in CM.
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