MR angiography of large-vessel intracranial stenosis after cryptococcal meningitis

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Abstract

We present a case of cryptococcal meningoencephalitis producing narrowing of both middle cerebral arteries on MRI/MRA, described in a 56-year-old man with a history of Wegener’s granulomatosis. Diagnosis was based on the presence of cryptococcal antigen in serum and CSF. Imaging performed seven months after initial presentation demonstrated thickened enhancing leptomeninges with focal inflammatory masses in the Sylvian fissures. To our knowledge, this striking appearance has not been previously demonstrated simultaneously on MRI/MRA.

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Most cited references 6

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Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis.

Chenhui Lu, Hong-Chang Lai, Howard H. Chang … (2001)

Twenty-eight patients with cerebral infarction secondary to chronic meningitis were retrospectively identified at our institution over a period of 5 years. They accounted for 47% (17/36) of tuberculous meningitis (TBM) and 32% (11/34) of cryptococcal meningitis cases. Single infarctions were found in 15 patients and multiple infarctions in 13. The distribution of single infarctions was: basal ganglia 7; internal capsule 3; thalamus 1; cerebellum 1; and cortical infarct 3. Therapeutic outcomes at 3 months were determined using a modified Barthel INDEX: At follow-up of 3 months or more, 10 had good outcomes while the other 18 had poor outcomes. The 18 with poor outcomes included six who died, and 12 who had severe neurological sequelae. TBM and cryptococcal meningitis shared similar clinical features, both being frequently associated with other neurological complications, including hydrocephalus, cranial nerve palsy, and seizures in our patients. However, extracranial involvement, such as spinal and pulmonary involvement, was more commonly found in TBM patients. Cerebral infarction can occur in both the acute stage and later stages of treatment. Mortality and morbidity are high, and early diagnosis and appropriate antimicrobial treatment are essential. If hydrocephalus is demonstrated, early ventricular decompression is needed to prevent further cerebral ischaemia.

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Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases.

R D Tien, P Chu, J Hesselink … (1991)

CT and MR scans of 29 immunocompromised patients (28 with AIDS or ARC, one with diabetes mellitus) who had documented intracranial cryptococcal infection were reviewed retrospectively. All patients had CT studies; 26 received iodinated contrast agent. CT findings included normal results in nine of 29, atrophy only in 13 of 29, nonenhancing lesions in three of 29, enhancing lesions in two of 20, and foci of leptomeningeal calcification in two of 29. Ten patients had both CT and MR studies, and four received gadopentetate dimeglumine. Among these 10 patients, five had normal CT studies and one showed moderate central atrophy. All 10, however, had abnormal MR findings. We observed four patterns: (1) parenchymal cryptococcoma (3/10); (2) numerous clustered tiny foci that were hyperintense on T2-weighted images and non-enhancing on postcontrast T1-weighted images, located relatively symmetrically in the basal ganglia bilaterally and in midbrain, representing dilated Virchow-Robin spaces (4/10); (3) multiple miliary enhancing parenchymal and leptomeningeal nodules (1/10); and (4) a mixed pattern, consisting of dilated Virchow-Robin spaces with mixed lesions such as cryptococcoma and miliary nodules (2/10). In the group of six patients with dilated Virchow-Robin spaces (patterns 2 and 4), two received gadopentetate dimeglumine, but the Virchow-Robin space lesions did not enhance; among the remaining four patients, two received gadopentetate dimeglumine (one with pattern 1 and one with pattern 3) and the lesions did enhance. Three patients in our study subsequently died and autopsies were performed. The postmortem results revealed dilated Virchow-Robin spaces filled with fungi in the basal ganglia, which correlated well with MR findings.(ABSTRACT TRUNCATED AT 250 WORDS)

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Tuberculous meningitis--a CT study.

P Tandon, S Bhargava, Meenakshi Gupta (1982)

This study comprises 60 cases of tuberculous meningitis including both adults and children. Only three cases showed a normal scan. Severe hydrocephalus was present in 87.09% children and only 12.09% adults. The incidence of hydrocephalus increased with the duration of the illness and decreased with age. Exudates in the basal cisterns were graded from mild to severe, the latter being seen only in children. Visible infarcts were shown in 28.33% of cases, 10% showed associated parenchymal tuberculomas. Serial follow-up scans indicate that patients with non-enhancing exudates have a good prognosis when medically treated, whereas in those cases with enhancing exudates the prognosis is poor in spite of medical treatment and surgical shunting; they either succumb to their illness or are left with irreversible sequelae. CT has proved sensitive in both the diagnosis and prognosis in clinically suspected tuberculous meningitis.

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Author and article information

Contributors

Arnold Kang

Journal

Journal ID (nlm-ta): Radiol Case Rep

Journal ID (iso-abbrev): Radiol Case Rep

Title: Radiology Case Reports

Publisher: Elsevier

ISSN (Electronic): 1930-0433

Publication date PMC-release: 06 November 2015

Publication date Collection: 2011

Publication date (Electronic): 06 November 2015

Volume: 6

Issue: 4

Electronic Location Identifier: 528

Author notes

[* ]Contact Dr. Kang akang79@ 123456uw.edu

[1]

Dr. Kang is a neuroradiology fellow, and Dr. Haynor is a professor of radiology, both at the University of Washington, Seattle WA.

Article

Publisher ID: S1930-0433(15)30193-X Publisher ID: 528

DOI: 10.2484/rcr.v6i4.528

PMC ID: 4899933

PubMed ID: 27307928

SO-VID: e6bc771d-f16a-43a4-8128-1b01fc0cc1f7

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

MR angiography of large-vessel intracranial stenosis after cryptococcal meningitis

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Abstract

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 6

Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis.

Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases.

Tuberculous meningitis--a CT study.

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