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Paracoccidioidomycosis of the central nervous system: CT findings
M A Rodacki1, G De Toni, L A Borba
1Section of Neuroradiology, Sta Isabel Hospital, Blumenau, Sta Catarina, Brazil.
Abstract:
A retrospective analysis of six cases of central nervous system paracoccidioidomycosis, all but one proven by biopsy and surgery, was carried out to study the CT and clinical data and pathological correlation. Most of the patients were from the country. Headache, vomiting, seizures and hemiparesis were the most frequent symptoms. Papilloedema was present in four patients with raised intracranial pressure. Five patients had chronic lung disease and two with advanced systemic disease, skin and mucous membrane lesions were also observed. The neurological disturbance was sometimes the presenting features and the diagnosis was discovered incidentally after surgery. Both solitary and multiple parenchymal lesions were observed and the cerebral hemispheres were more commonly involved in four patients. Local meningeal involvement was observed in one with a single cortical granuloma. We emphasise the usefulness of CT, showing a rounded or lobulated mass with an isodense or radiolucent centre after contrast enhancement, surrounded by an irregular wall of varying thickness. There was always moderate oedema, extending peripherally. Other infections or neoplastic diseases may present similar findings. Preoperative diagnosis should rest on integration of clinical data, chest films, laboratory and neuroimaging studies.
Insights
Central nervous system paracoccidioidomycosis can present with varied neurological symptoms. Computed tomography (CT) aids in diagnosing these central nervous system (CNS) infections, revealing characteristic lesion patterns.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Paracoccidioidomycosis is a systemic fungal infection endemic to Latin America.
- Central nervous system involvement is a severe manifestation, often presenting with nonspecific neurological symptoms.
Purpose of the Study:
- To analyze clinical and CT findings in central nervous system paracoccidioidomycosis.
- To correlate imaging findings with pathological data.
- To emphasize the diagnostic utility of CT in CNS paracoccidioidomycosis.
Main Methods:
- Retrospective analysis of six cases of central nervous system paracoccidioidomycosis.
- Review of clinical data, CT scans, and pathological findings (biopsy/surgery).
Main Results:
- Common symptoms included headache, vomiting, seizures, and hemiparesis.
- CT demonstrated rounded or lobulated masses with central hypoattenuation and irregular enhancing walls, often with surrounding edema.
- Neurological symptoms could be the initial presentation, with diagnosis sometimes incidental after surgery.
Conclusions:
- CT is a valuable tool for diagnosing central nervous system paracoccidioidomycosis, showing characteristic imaging features.
- Preoperative diagnosis requires integrating clinical, radiological, and laboratory data.
- Differential diagnosis should consider other infectious and neoplastic conditions presenting similar imaging findings.