title: Percutaneous transluminal angioplasty in a patient with vasospasm secondary to coccidioidal meningitis: case report and review of the literature.
abstract: BACKGROUND
  Coccidioidomycosis is secondary to infection with fungal species Coccidioides immitis or Coccidioides posadasii. One consequence of extrapulmonary coccidioidomycosis dissemination is meningitis, which is associated with high rates of morbidity and mortality if left untreated. Intracranial vasospasm, although rarely described, can occur and may be a result of vasculitic or subacute fibrotic changes. We describe a case of successful percutaneous transluminal angioplasty (PTA) in a patient with severe vasospasm related to coccidioidal meningitis. This is the first report of this endovascular treatment used to treat coccidioidal vasospasm.
  
  
  METHODS
  A patient with a history of pulmonary coccidioidomycosis presented with acute confusion, blurry vision and headache. Serology confirmed basilar meningitis and magnetic resonance angiography demonstrated severe symptomatic vasospasm.
  
  
  METHODS
  Emergent cerebral angiography confirmed severe vasospasm in the right middle cerebral artery and moderate vasospasm in the left middle cerebral artery. Successful PTA was performed under general anesthesia. The patient demonstrated postprocedural angiographic and clinical improvement.
  
  
  CONCLUSIONS
  We report the first case of successful PTA performed to treat vasospasm related to coccidioidal meningitis. When vasospasm is clinically symptomatic, PTA is a safe and feasible procedure.
authors: Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
authors: Yin C
authors: YC
authors: Hu
authors: C Benjamin
authors: CB
authors: Newman
authors: Ruth
authors: R
authors: Bristol
authors: Cameron G
authors: CG
authors: McDougall
authors: Felipe C
authors: FC
authors: Albuquerque
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods / Q000639:trends; D003045:Coccidioides / Q000472:pathogenicity*; D003047:Coccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D020768:Middle Cerebral Artery / Q000382:microbiology / Q000601:surgery; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy*