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      Seizure in isolated brain cryptococcoma: Case report and review of the literature

      case-report

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          Abstract

          Background:

          Central nervous system (CNS) cryptococcosis is an invasive fungal infection predominantly seen among immunosuppressed patients causing meningitis or meningoencephalitis. Rarely, cryptococcosis can affect immunologically competent hosts with the formation of localized CNS granulomatous reaction, known as cryptococcoma. Common symptoms of CNS cryptococcoma are headaches, consciousness or mental changes, focal deficits, and cranial nerve dysfunction. Rarely, seizures are the only presenting symptom.

          Case Description:

          We report the case of an immunocompetent patient with a solitary CNS cryptococcoma presenting with a long history of non-responsive generalized seizure who has been successfully operated.

          Conclusion:

          CNS cryptococcoma is a rare entity, and in immunocompetent patients, its diagnosis can be challenging. The pathophysiology of lesion-related seizure is discussed along with a review of the pertinent literature.

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          Most cited references22

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          Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.

          John R. Perfect, William E. Dismukes, Francoise Dromer … (2010)
          Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
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            Cryptococcosis.

            Eileen Maziarz, John Perfect (2016)
            Cryptococcosis is an invasive mycosis caused by pathogenic encapsulated yeasts in the genus Cryptococcus. Cryptococcus gained prominence as a pathogen capable of widespread disease outbreaks in vulnerable populations. We have gained insight into the pathobiology of Cryptococcus, including the yeast' s capacity to adapt to environmental pressures, exploit new geographic environments, and cause disease in both immunocompromised and apparently immunocompetent hosts. Inexpensive, point-of-care testing makes diagnosis more feasible than ever. The associated worldwide burden and mortality remains unacceptably high. Novel screening strategies and preemptive therapy offer promise at making a sustained and much needed impact on this sugar-coated opportunistic mycosis.
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              Infections, inflammation and epilepsy.

              Annamaria Vezzani, Robert Fujinami, H White … (2016)
              Epilepsy is the tendency to have unprovoked epileptic seizures. Anything causing structural or functional derangement of brain physiology may lead to seizures, and different conditions may express themselves solely by recurrent seizures and thus be labelled "epilepsy." Worldwide, epilepsy is the most common serious neurological condition. The range of risk factors for the development of epilepsy varies with age and geographic location. Congenital, developmental and genetic conditions are mostly associated with the development of epilepsy in childhood, adolescence and early adulthood. Head trauma, infections of the central nervous system (CNS) and tumours may occur at any age and may lead to the development of epilepsy. Infections of the CNS are a major risk factor for epilepsy. The reported risk of unprovoked seizures in population-based cohorts of survivors of CNS infections from developed countries is between 6.8 and 8.3 %, and is much higher in resource-poor countries. In this review, the various viral, bacterial, fungal and parasitic infectious diseases of the CNS which result in seizures and epilepsy are discussed. The pathogenesis of epilepsy due to brain infections, as well as the role of experimental models to study mechanisms of epileptogenesis induced by infectious agents, is reviewed. The sterile (non-infectious) inflammatory response that occurs following brain insults is also discussed, as well as its overlap with inflammation due to infections, and the potential role in epileptogenesis. Furthermore, autoimmune encephalitis as a cause of seizures is reviewed. Potential strategies to prevent epilepsy resulting from brain infections and non-infectious inflammation are also considered.
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                Author and article information

                Contributors
                Laura Brunasso
                Roberta Costanzo
                Antonio Cascio
                Ada Florena
                Gianvincenzo Sparacia
                Domenico Gerardo Iacopino
                Giovanni Grasso
                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Title: Surgical Neurology International
                Publisher: Scientific Scholar (USA )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2021
                Publication date (Electronic): 14 April 2021
                Volume: 12
                Electronic Location Identifier: 153
                Affiliations
                [1 ]Department of Biomedicine, Neurosciences and Advanced Diagnostic, Section of Neurosurgery, University of Palermo, Palermo, Italy.
                [2 ]Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Palermo, Italy.
                [3 ]Department of Health Promotion Sciences, Pathology Unit, University of Palermo, Palermo, Italy.
                [4 ]Department of Diagnostic and Therapeutic Services, and Neurology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Radiology Service, University of Palermo & ISMETT, Palermo, Italy.
                Author notes
                [* ] Corresponding author: Giovanni Grasso, Department of Biomedicine, Neurosciences and Advanced Diagnostic, Section of Neurosurgery, University of Palermo, Palermo, Italy. giovanni.grasso@ 123456unipa.it

                Article
                Publisher ID: 10.25259/SNI_805_2020
                DOI: 10.25259/SNI_805_2020
                PMC ID: 8088491
                PubMed ID: 33948323
                SO-VID: ffe3742e-69cc-4093-b3b2-db0f518a85eb
                Copyright © Copyright: © 2021 Surgical Neurology International
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 11 November 2020
                Date accepted : 10 March 2021
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: central nervous system,cryptococcoma,seizure
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: central nervous system, cryptococcoma, seizure

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