Cryptococcal meningitis presenting as pseudosubarachnoid hemorrhage.
A 50-year-old man presented with progressive visual loss, headache, and two days of confusion. A computed tomography of his head suggested subarachnoid hemorrhage with accompanying right parietal ischemic infarction. The magnetic resonance image was consistent with right parietal perisulcal pial and superficial cortical inflammation; a subjacent vasogenic edema with a 1 cm diameter abscess was also present. Funduscopy revealed bilateral multifocal choroidal lesions and retinal perivascular sheathing. He was diagnosed with pseudosubarachnoid hemorrhage secondary to cryptococcal meningitis and choroidal microabscesses with retinal inflammation after a cerebrospinal fluid (CSF) examination revealed cryptococcal yeast forms, as well as high titers of CSF cryptococcal antigen, but no CSF red blood cells.
Hoque
Romy
R
Department of Neurology, Louisiana State University School of Medicine-Shreveport, Shreveport, LA 71103, USA. romy.hoque@gmail.com
Gonzalez-Toledo
Eduardo
E
Jaffe
Stephen L
SL
D001922:Brain Abscess / Q000175:diagnosis; D001929:Brain Edema / Q000175:diagnosis; D002544:Cerebral Infarction / Q000175:diagnosis; D015862:Choroid Diseases / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis*; D008875:Middle Aged; D019721:Ophthalmoscopes; D010296:Parietal Lobe / Q000098:blood supply; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed