Presentation
Seizures and altered sensorium. Immunocompetent status.
Patient Data
Mild enhancing pachymeningeal and leptomeningeal thickening along basal and interpeduncular cisterns and the sulci in bilateral para sagittal superior frontal regions.
There are a few small, patchy T2W/FLAIR hyperintense areas in the bilateral basal ganglia regions.
Small patchy area of diffusion restriction in the left basal ganglia region with corresponding hypointensity on ADC.
A small area of blooming on GRE with the corresponding hyperintensity on SWI likely represents thrombus/hemorrhage.
A small, hyperdense tubular area in the left basal ganglia region likely represents a thrombus.
The CSF study shows cryptococcus antigen detection in CSF and cryptococcus-like organisms in Indian ink preparation.
Case Discussion
Overall findings are suggestive of cryptococcal meningoencephalitis with acute ischemic stroke.
Co-author: Dr. Sanaullah Mudassir (DM, Neuromedicine).
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