Friday January 20, 2006
Cryptococcosis meningitis !!
5 tips to differential diagnose cryptococcosis meningitis.
1. Neck stiffness is uncommon rather non-specific signs may be present ranging anything from headache to coma including personality change.
2. CT scan or MRI should be performed prior to Lumbar punture (LP) and may present with specific findings of leptomeningeal enhancement and enlarged Virchow-Robin spaces. CT scan and MRI may be normal but if scan shows mass lesion (cryptococcomas), avoid LP and consult a neurosurgeon.
See images here, Radiological findings in CNS cryptococcus, from Journal of the chinese medical association 2003;66: 19-26
3. High opening pressure on LP (greater than 200 mm H2O) is common and may have trio of low glucose, high protein and more lymphocytes but CSF may be normal !!. The cryptococcal organism is surrounded by a polysaccharide capsule, which may protect it from the host inflammatory response.
4. Make sure to send CSF for india ink. 5
5. Eye exam is essential to r/o optic neuritis, endophthalmitis or compressive optic neuropathy from high intracranial pressure. Quick treatment can salvage patient vision and emergent opthalmology and neurosurgical consults are indicated. (see healthy discussion at ref. # 3).
References: click to get abstrat/article
1. Overwhelming CNS cryptococcus in AIDS - Neurology 2001 57: 1560
2. Central Nervous System Cryptococcal Invasion - hivinsite.ucsf.edu
3.. Cryptococcal Meningitis Resulting in Irreversible Visual Impairment in AIDS Patients - A Report of Two Cases - SINGAPORE MEDICAL JOURNAL
4. Cryptococcosis - emedicine.com
5. CNS Infections Laboratory - ratsteachmicro.com