A Case of Cryptococcal Meningitis.

Park, Kyung Soo; Kim, Jung Shick; Han, Dae Hee

Original Article

Journal of Korean Neurosurgical Society 1976;5(1): 77-80.

Kyung Soo Park, Jung Shick Kim, Dae Hee Han

Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea.

ABSTRACT

Cryptococcosis of the central nervous system if highly fatal, if unteated, but we experienced a case of cryptococcal meningitis that took a rather benign course with a marked hydrocephalus with deafness and visual disturbance simulating tuberculous meningitis clinically. A 31 year old Korean man was admitted to the department of Neurosurgery, Seoul National University Hospital, with the chief complaints of sudden visual disturbance and bilateral deafness of 4 years' duration. Simple skull films showed a sellar changes that was due to chronically increased intracranial pressure. Carotid angiogram revealed marked hydrocephalic changes and vertebral angiogram showed a 4th ventricle dilatation. On pneumoencephalogram, we could observe air trapping only below the tentorium. Conray ventriculogram showed marked dilatation of all ventricles. The 3rd ventricle was herniated into the sella and irregular filling defect at the posteroinferior portion of the 4th ventricle was observed. Lumbar CSF showed the finding compatible with tuberculous meningitis. India ink staining of CSF for fungus study gave a negative result. Posterior fossa exploration was performed to rule out possible mass lesion. Arachnoid membrance was thickened and adhered, so we couldn't separate tonsils and explore the 4th ventricle. And there was no CSF in the cisterna magna. We found a mass of yellowish and caseous material in the dorsal aspect of lower medulla. Ventriculo-operational shunt for hydrocephalus was done. Microscopic findings of the lesion revealed diffuse infiltration of many cryptococci with scattered neutrophils and monocytes. We report a case of cryptococcal meningitis that took and unusual benign course.