Cerebral venous sinus thrombosis secondary to neurocryptococcosis

[摘要] A 41-year-old man presented with headache, fever, mild bilateral papilledema, and neck stiffness. Brain magnetic resonance imaging (MRI) showed leptomeningeal enhancement and dilated perivascular spaces with peripheral enhancement in the basal ganglia (Figure 1), and cerebral venous thrombosis (Figure 2). Cerebrospinal fluid (CSF) examination revealed 22 white blood cells (94% lymphocytes), with glucose and protein concentrations of 28 mg/dL and 137 mg/dL, respectively. CSF culture was positive for Cryptococcus neoformans. A test for human immunodeficiency virus was positive (viral load: 537,969 copies/mL) and CD4+ count was 11 cells/mL. Treatment was started with the induction phase with amphotericin B lipid complex (400 mg, once daily) and fluconazole (600 mg, twice daily) for 30 days. Symptom regression was observed, and the consolidation phase was maintained for eight weeks with fluconazole (450 mg twice a day). FIGURE 1: Post-contrast axial T1-weighted images showing leptomeningeal enhancement of the interpeduncular fossa and right superior frontal sulcus (arrows, A and B). Axial T2-weighted image showing dilated perivascular spaces in the basal ganglia (arrows, C).

[学科分类] 农业科学（综合）