An Uncommon Presentation of Cryptococcal Meningoencephalitis

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.