Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients

Duarte, Stênio Bruno Leal; Oshima, Mariana Mari; Mesquita, João Vitor do Amaral; Nascimento, Felipe Barjud Pereira do; Azevedo, Paula; Reis, Fabiano

doi:10.1590/0100-3984.2016.0017

Cited by 52 publications

(58 citation statements)

References 17 publications

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“…The MRI visualisation of pathological processes that take place in the brain is undoubtedly of great diagnostic value, especially in differential diagnosis or when an adequate laboratory testing is not possible or provides uncertain results [24][25][26]. In cerebral toxoplasmosis, multiple lesions are a common implication.…”

Section: Discussionmentioning

confidence: 99%

Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia)

et al. 2020

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Cerebral toxoplasmosis is a leading cause of the central nervous system disorders in acquired immune deficiency syndrome. This study aimed to investigate the clinical course of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected individuals. The study included 90 HIV-infected patients with cerebral toxoplasmosis, who underwent inpatient treatment. In case of positive enzyme immunoassay, HIV infection was confirmed with the immunoblot test. The HIV-1 ribonucleic acid level was determined using the polymerase chain reaction method. The flow cytometry was used for counting CD4 (cluster of differentiation 4 cells). Pathomorphological examination included the autopsy, gross and microscopic examination of internal organs, histological and other methods. The incidence of cerebral toxoplasmosis significantly increases at the CD4 count below 100 cells/μl, P < 0.001, and at the HIV viral load above 50 copies/ml, P < 0.05. The clinical picture of cerebral toxoplasmosis included focal symptoms, cognitive impairment, toxic syndrome, mild cerebral symptoms and a meningeal symptom. Given the absence of a specific clinical picture and the absence of abnormal laboratory and instrumental findings, the cerebral toxoplasmosis needs to be diagnosed with a number diagnostic methods combined: clinical examination, laboratory testing, immunological examination, molecular genetic testing and neuroradiological imaging.

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Section: Discussionmentioning

confidence: 99%

Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia)

et al. 2020

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“…5 Furthermore, there are no specific imaging differences between immunocompetent and immunocompromised patients with cryptococcal meningitis. 7 The polysaccharide capsule is the major virulence factor and substrate detected by cryptococcal antigen testing. CSF in HIV-negative patients is likely to show lymphocytic pleiocytosis, elevated protein, and low glucose.…”

Section: Discussionmentioning

confidence: 99%

Clinical Reasoning: Immunocompetent patient with multiple cranial nerve palsies, ataxia, and cognitive decline

2020

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A 71-year-old woman with a 4-month history of recurrent headaches refractory to treatment presented to her primary care physician's office with persistent headaches, generalized weakness, and a droopy left eyelid. During initial hospital assessment, she endorsed a 20-pound weight loss. She denied any fever, neck stiffness, or photophobia. Her medical history was significant for type II diabetes mellitus and hypertension (both well-controlled and off medications). On examination, the patient was alert and oriented to person, place, and time. Her speech was dysarthric and she had difficulty with word-finding and following 2-step commands. Pupils were 3 mm and equally reactive to light. She had complete ptosis of the left eyelid, and her left eye was down and out at rest. The left eye was able to abduct and look down, but unable to adduct. The right eye was able to abduct and look down, but unable to go past midline when adducting. Upward gaze was limited in both eyes. Eyelid closure was weak bilaterally, but weaker on the left. Facial sensation to light touch was decreased in the V2 distribution bilaterally, and the patient also exhibited mild left facial droop. Hearing was intact. Shoulder shrug was intact. No palate or tongue weakness/asymmetry was noted. Strength in upper and lower limbs was 5/5 throughout. Deep tendon reflexes were 2+ and symmetric throughout. Toes were downgoing bilaterally. Sensation to light touch, pinprick, and temperature was intact on the right side, but diminished in the left arm and leg throughout and did not fit with a peripheral nerve distribution. Truncal ataxia was noted when sitting up and walking. She had an unsteady, wide-based gait, and her balance did not worsen with eyes closed.

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“…The most common clinical findings in CNS cryptococcal infection are headache, nausea and fever. Less common manifestations are meningism, altered mental state, seizures, visual symptoms and focal neurological deficits [59]. The brain regions most commonly affected are the basal ganglia and meninges.…”

Section: Cryptococcosismentioning

confidence: 99%

“…In the basal ganglia, a localized cluster of organisms may develop gelatinous pseudocysts [58]. Cryptococcomas (accumulations of fungi, inflammatory cells and gelatinous mucoid material) appear during the infection and can extend to the parenchyma as focal masses with a tumour-like appearance [59]. Duarte et al [59]…”

Section: Cryptococcosismentioning

confidence: 99%

Brain miliary enhancement

et al. 2020

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Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted postcontrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.

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Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients

Cited by 52 publications

References 17 publications

Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia)

Cerebral toxoplasmosis in HIV-infected patients over 2015–2018 (a case study of Russia)

Clinical Reasoning: Immunocompetent patient with multiple cranial nerve palsies, ataxia, and cognitive decline

Brain miliary enhancement

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