title: Central nervous system infections masquerading as cerebrovascular accidents: Case series and review of literature.
abstract: Central nervous system (CNS) infections can have various presentations including Cerebrovascular accidents (CVA) which may go unrecognized as a presentation of infection. We describe three cases of different CNS infections complicated by CVA.
  
  
  
  Case 1 describes a 27-year-old man, presenting with symptoms consistent with a transient ischemic attack found to have racemose neurocysticercosis. Case 2 describes a 55-year-old man with low grade fevers for 4 weeks accompanied by visual and gait disturbances and delayed speech diagnosed with multiple small left thalamocapsular and superior cerebellar infarcts secondary to cryptococcal meningitis. The third case describes a man with pneumococcal meningitis complicated by cerebellar infarcts.
  
  
  
  CNS vascular compromise secondary to infections may be due to vasculitis, an immune-mediated parainfectious process causing vasospasm or thrombosis, or a hypercoagulable state with endothelial dysfunction. Patients with CVAs are at risk for aspiration pneumonia, urinary tract infections (especially catheter related) and other nosocomial infections and their clinical presentation may be very similar to CNS infections.
  
  
  
  The cases described demonstrate that CNS infections need to be considered in the differential diagnosis of CVAs presenting with fevers. The signs and symptoms of non-CNS infections associated with CVAs may be clinically indistinguishable from those of CNS infections. The outcomes of untreated CNS infections are extremely poor. It is thus imperative to have a high index of suspicion for CNS infection when evaluating CVAs with fevers or other signs of infection.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Hofstra North Shore-LIJ School of Medicine, 400 Community Drive, Manhasset, NY 11030, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hayes
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Hofstra North Shore-LIJ School of Medicine, 400 Community Drive, Manhasset, NY 11030, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Malhotra
keywords: CNS; Cerebrovascular; Cryptococcus; Infections; Neurocysticercosis
references.citation: Lancet. 1996 Feb 10;347(8998):399
references.pmid: 8598723
references.citation: J Indian Med Assoc. 2009 Jun;107(6):372-7
references.pmid: 19886375
references.citation: Clin Infect Dis. 1995 Mar;20(3):611-6
references.pmid: 7756484
references.citation: Neurology. 2004 Aug 24;63(4):713-4
references.pmid: 15326249
references.citation: Circulation. 2004 Jun 8;109(22):2698-704
references.pmid: 15184294
references.citation: J Neurol Neurosurg Psychiatry. 1992 Apr;55(4):252-4
references.pmid: 1583508
references.citation: Stroke. 1992 Feb;23 (2):224-8
references.pmid: 1561652
references.citation: Brain. 2003 May;126(Pt 5):1015-25
references.pmid: 12690042
references.citation: N Engl J Med. 2002 Nov 14;347(20):1549-56
references.pmid: 12432041
references.citation: Neurology. 2010 Jul 13;75(2):193; author reply 193-4
references.pmid: 20625175
references.citation: Stroke. 1989 Aug;20(8):1095-9
references.pmid: 2756543
references.citation: N Engl J Med. 2006 Jan 5;354(1):44-53
references.pmid: 16394301
references.citation: Arch Neurol. 1996 Mar;53(3):233-9
references.pmid: 8651876
references.citation: Neurocrit Care. 2006;4(3):237-40
references.pmid: 16757830
references.citation: Neurology. 1992 Aug;42(8):1497-504
references.pmid: 1641143
references.citation: Neurocrit Care. 2010 Oct;13(2):217-27
references.pmid: 20526697
references.citation: Semin Neurol. 2011 Jul;31(3):286-306
references.pmid: 21964846