Cryptococcal leptomeningitis with basal ganglia involvement

Case contributed by Dr Mauricio Macagnan

Presentation

Complains of altered sensorium and weakness. History of HIV/AIDS.

Patient Data

Age: 45 years
Gender: Female

Lesions in the lentiform and caudate nuclei (basal ganglia), some cystic in nature, with a left-sided predominance.

Temporo-parieto-occipital leptomeningeal enhancement on the right and in the right precentral sulcus, with adjacent vasogenic edema, more evident on the FLAIR sequence, with possible small areas of associated parenchymal enhancement.

Case Discussion

The patient has a history of HIV/AIDS, with previous cryptococcal meningitis, presenting with a lowered level of consciousness and headache. CSF screening positive for cryptococcus.

In patients with severe immunosuppression, infection of the meninges diffuses into the cerebral parenchyma through the ependymal and subarachnoid spaces. This leads to the accumulation of fungus-rich mucinous exudates, expressed by dilation of the perivascular (Virchow-Robin) spaces. Such exudates can further evolve into mucinous cysts, with a predilection for the basal ganglia and periventricular regions.

In this case, there is a lesion in the basal ganglia that does not show contrast enhancement. There is, however, leptomeningeal enhancement, which is characteristic of cryptococcal leptomeningitis.

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Case information

rID: 53172
Case created: 4th May 2017
Last edited: 17th May 2017
Inclusion in quiz mode: Included

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