title: Curtains.
abstract: A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.
authors.affiliation: University of Arkansas Medical Center, and Arkansas Children’s Hospital, Little Rock, Arkansas 72202, USA. PhillipsPaulH@uams.edu
authors.forename: Paul H
authors.initials: PH
authors.lastname: Phillips
authors.forename: Edgardo
authors.initials: E
authors.lastname: Angtuaco
authors.forename: Rudy L
authors.initials: RL
authors.lastname: VanHemert
authors.forename: Rod
authors.initials: R
authors.lastname: Foroozan
mesh_terms: D001763:Blepharoptosis / Q000209:etiology*; D001927:Brain Diseases / Q000175:diagnosis; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis; D015840:Oculomotor Nerve Diseases / Q000209:etiology*