Torulomas (cryptococcal granulomata) of the central nervous system

Selby, Roy; Lopes, Nilo Mario Monteiro

doi:10.3171/jns.1973.38.1.0040

Cited by 35 publications

(19 citation statements)

References 33 publications

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“…6 ' 7 These patients generally have a slowly progressive deficit, unlike patients with acute vascular insults.…”

Section: Discussionmentioning

confidence: 99%

Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis.

Saul¹,

Gallagher²,

Mateer³

1986

Stroke

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SUMMARY A previously healthy young man presented with an acute stroke syndrome and was found to have cryptococcal organisms in the CSF. Though an initial CSF examination for an infectious etiology was negative, a second lumbar puncture was performed because of hypoglycorrhachia, which established the diagnosis. An uneventful recovery followed the administration of Amphotericin B and 5-Flucytosine.A literature search revealed only one previously reported case of cryptococcal meningoencephaiitis presenting as a stroke. The need for performing a CSF examination on young patients presenting with a cerebrovascular event, and the aggressive investigation of unexplained hypoglycorrhachia are emphasized. Stroke Vol 17, No 4, 1986 CRYPTOCOCCUS NEOFORMANS invading the central nervous system most commonly presents with symptoms and signs characteristic of meningitis, meningoencephaiitis, or a mass lesion. "3 Headache, with concomitant nuchal rigidity, decline in mental function, papilledema, and later progressive focal signs, are the most commonly encountered features of this illness. A sudden hemiparesis as the presenting sign of cryptococcal meningoencephaiitis is rare, having been reported only once in the literature. 3 We report a second case which we believe represents a sudden occlusion of a small hemispheric branch of the right middle cerebral artery secondary to a focal area of vasculitis, or a septic embolism to the right internal capsular branches. Case ReportA 36-year-old male university meteorologist was in good health until nine months prior to admission, when he developed the insidious onset of bioccipital and retro-orbital headaches that required regular analgesia for relief. He was able to continue his occupation, but was plagued by the nagging headache. A diagnosis of sinusitis had been made by one physician, and he was treated with a course of an antibiotic without relief. Two weeks prior to his current admission his headaches worsened, and one day prior to admission, he noted the sudden inability to place his left hand on a computer keyboard. There was some associated left leg and thigh numbness, and his wife noted that his speech was slurred. His colleagues noted a facial weakness. He was taken to a local hospital where his examination showed a normal mental status, an easily recognizable left facial weakness, a mild left hemipa- He was transferred to our institution the following day. Further history revealed hands-on exposure to some cockatoos at an exotic bird farm ten months earlier. He was afebrile and his general physical examination was normal. The neurological examination was unchanged. A repeat CT scan with contrast was normal. The peripheral white blood cell count was 5,500/mm 3 , with 68% polymorphonuclear leukocytes, 1% bands, 21% lymphocytes, 5% mononuclear cells, 4% eosinophils, and 1% basophils. The hematocrit was 39%, Westergren sedimentation rate was 5 mm/hr, BUN was 11 mg/dl, and creatinine was 1.1 mg/dl. A chest X ray was normal. An EKG showed left axis deviation. A repeat lumbar p...

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“…6 ' 7 These patients generally have a slowly progressive deficit, unlike patients with acute vascular insults.…”

Section: Discussionmentioning

confidence: 99%

Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis.

Saul¹,

Gallagher²,

Mateer³

1986

Stroke

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“…A avaliação da TC em uma série de 29 pacientes imunodeprimidos com infecção criptocócica do SNC revelou que o exame foi normal em 9 pacientes (31,03%), com graus variados de atrofia em 13 (44,84%), lesões sem captação de contraste em 3 (10,35%) que correspoderiam à massa gelatinosa de fungo, 2 com focos de calcificação (6,89%) e apenas 2 com lesões captantes de contraste ou forma granulomatosa (6,89%) 13 . Tanto a hipoatenuação da substância branca, como a hipercaptação difusa do contraste foram consideradas como reação inflamatória meníngea, dos espaços de VirchowRobin e do tecido cerebral adjacente 4,13 .…”

Section: Comentáriosunclassified

“…Tanto a hipoatenuação da substância branca, como a hipercaptação difusa do contraste foram consideradas como reação inflamatória meníngea, dos espaços de VirchowRobin e do tecido cerebral adjacente 4,13 . As lesões nodulares da criptococose parenquimatosa localizam-se preferencialmente à nível de gânglios da base e tálamo 3,4 .…”

Section: Comentáriosunclassified

“…Por não serem específicos, os aspectos das lesões na TC podem ser indistinguiveis de outras infecções fúngicas, cisticercose, equinococose e abcesso cerebral de várias etiologias 5,6,13 . A RM pode auxiliar no diagnóstico diferencial em caso de dilatação dos espaços perivasculares de VirchowRobin ao nível de gânglios da base, tálamo e tronco cerebral 4,13 .…”

Section: Comentáriosunclassified

“…A RM pode auxiliar no diagnóstico diferencial em caso de dilatação dos espaços perivasculares de VirchowRobin ao nível de gânglios da base, tálamo e tronco cerebral 4,13 .…”

Section: Comentáriosunclassified

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Forma granulomatosa da criptococose cerebral: relato de caso

Fobe

Buone

Costa

1995

Arq. Neuro-Psiquiatr.

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RESUMO -A criptococose do sistema nervoso central na sua forma granulomatosa ou criptococoma é rara, sendo mais freqüente a forma meningítica ou meningoencefalítica. Apresentamos o case de um paciente de 56 anos, não portador da síndrome de imunodeficiência adquirida, com manifestação clínica inicial de síndrome de hipertensão intracraniana em decorrência de criptococoma occípito-parietal que foi removido cirurgicamente, seguido do tratamento medicamentoso com anfotericina-B e 5-fIuorocitosina. A fisiopatologia, o diagnóstico por imagem e o tratamento são revistos.PALAVRAS-CHAVE: criptococose, cérebro, criptococoma, criptococose forma granulomatosa.Cryptococcal granuloma of the brain: case report SUMMARY -Cryptococcal granuloma or toruloma of the central nervous system is very rare, meningoencefalitis or meningitis being most common. The authors present the case of an immunocompetent male patient of 56 years old with initial clinical symptoms of intracranial hypertension due to an occípito-parietal crytococcal granuloma that was removed surgically. The patients was treated post operatively with anphotericin-B and 5-fluorcytosine. Pathophysiology, neuroimaging, diagnosis and treatment of this rare entity are discussed. KEY-WORDS: cryptococcosis, brain, toruloma, cryptococcal granuloma.A infecção pelo Cryptococcus neoformans do sistema nervoso central (SNC) causa freqüentemente meningite ou meningoencefalite, sendo raros os casos com formação de granulomas (criptococoma). A meningite ou meningoencefalite ocorrem principalmente em pacientes imunodeprimidos por diversas etiologias, sendo a forma granulomatosa encontrada em pacientes imunocompetentes. O criptococoma apresenta-se como lesão expansiva intraparenquimatosa, com efeito de massa, traduzindo-se clinicamente por manifestações neurológicas focais ou síndrome de hipertensão intracraniana. O diagnóstico por imagem através da tomografia computadorizada (TC) ou ressonância magnética (RM) de crânio do criptococoma é totalmente inespecífíco admitindo como diagnósticos diferenciais: tumores primários ou secundários, infarto e abscesso cerebral.Os autores relatam o caso de um paciente de 58 anos, imunocompetente, com criptococose do SNC na forma granulomatosa. Os aspectos à neuroimagem, fisiopatologia e tratamento são apresentados.

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The Cerebellum and CNS Infection

Cohen¹,

Lipton²

1990

Infections of the Nervous System

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Torulomas (cryptococcal granulomata) of the central nervous system

Cited by 35 publications

References 33 publications

Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis.

Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis.

Forma granulomatosa da criptococose cerebral: relato de caso

The Cerebellum and CNS Infection

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