Midbrain infarction: a rare presentation of cryptococcal meningitis.
A 20-year-old farmer who had headache and fever for 1 month, suddenly developed left hemiplegia, tremor in left arm and titubation followed by deep coma. Cranial CT scan revealed an infarction in right crus of midbrain. His CSF revealed 66 mg/dl protein, 10 lymphocytes/mm3, and 70 mg/dl glucose. CSF was positive for cryptococcal antigen. He improved following i.v. amphotericin 0.5 mg/kg and fluconazole 200 mg daily, continued for 6 and 12 weeks respectively. Infarctions though rare in cryptococcal meningitis should be considered in patients with chronic meningitis with vasculitis.
Kalita
J
J
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Bansal
R
R
Ayagiri
A
A
Misra
U K
UK
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000382:microbiology*; D002908:Chronic Disease; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000188:drug therapy; D008636:Mesencephalon / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole