Abstract
We encountered a patient with cryptococcal meningitis who developed superior sagital sinus occlusion during his clinical course.
A 50-year-old male with diabetes who developed a headche, neck stiffness, followed by fever and conciousness disturbance was admitted to our department. On admission, neurogical examinations showed slight disorientation, meningeal irritating signs, hypesthesia in the periphery of 4 limbs, and anisocoria. The cerebrospinal fluid obtained under an initial pressure of 160 mmH2O showed a cell count of 136/mm3, a protein level of 400 mg/dl, and a glucose level of 16 mg/dl (blood sugar 240 mg/dl). India ink staining demonstrated cryptococcus neoformans.
The symptoms slightly improved after treatment with Amphotericine B and 5-FC. About 3 months after the initiation of treatment, however, right hemiparesis suddenly developed. Brain CT showed multiple low density areas, the empty triangle sign, and gyral enhancement, while angiography showed no abnormality in the arterial phase but delayed enhancement in the cortical vein and poor enhancement of the posterior 1/3 portion of the superior sagittal sinus in the venous phase. Cryptococcosis is considered to be less frequently complicated by vascular damages than mucomycosis or aspergillosis. This case may be the first in which sperior sagittal sinus occlusion as a complication was radiologically demonstrated.
