Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
J Neurointerv Surg. 2011 Mar;3(1):62-5. doi: 10.1136/jnis.2010.002386. Epub 2010 Aug 23.
Coccidioidomycosis is secondary to infection with fungal species Coccidioides immitis or Coccidioides posadasii. One consequence of extrapulmonary coccidioidomycosis dissemination is meningitis, which is associated with high rates of morbidity and mortality if left untreated. Intracranial vasospasm, although rarely described, can occur and may be a result of vasculitic or subacute fibrotic changes. We describe a case of successful percutaneous transluminal angioplasty (PTA) in a patient with severe vasospasm related to coccidioidal meningitis. This is the first report of this endovascular treatment used to treat coccidioidal vasospasm.
A patient with a history of pulmonary coccidioidomycosis presented with acute confusion, blurry vision and headache. Serology confirmed basilar meningitis and magnetic resonance angiography demonstrated severe symptomatic vasospasm.
Emergent cerebral angiography confirmed severe vasospasm in the right middle cerebral artery and moderate vasospasm in the left middle cerebral artery. Successful PTA was performed under general anesthesia. The patient demonstrated postprocedural angiographic and clinical improvement.
We report the first case of successful PTA performed to treat vasospasm related to coccidioidal meningitis. When vasospasm is clinically symptomatic, PTA is a safe and feasible procedure.
球孢子菌病是由真菌物种粗球孢子菌或波萨达斯球孢子菌感染引起的。肺外球孢子菌病传播的一个后果是脑膜炎，如果不治疗，脑膜炎的发病率和死亡率很高。尽管颅内血管痉挛很少被描述，但可能会发生，这可能是血管炎或亚急性纤维性变化的结果。我们描述了一例成功的经皮腔内血管成形术（PTA）治疗与球孢子菌性脑膜炎相关的严重血管痉挛的病例。这是首例报道这种血管内治疗用于治疗球孢子菌性血管痉挛的病例。
一位有肺部球孢子菌病病史的患者出现急性意识模糊、视力模糊和头痛。血清学证实基底脑膜炎，磁共振血管造影显示严重症状性血管痉挛。
紧急脑血管造影证实右侧大脑中动脉严重血管痉挛，左侧大脑中动脉中度血管痉挛。在全身麻醉下成功进行了 PTA。患者术后血管造影和临床症状均有改善。
我们报告了首例成功进行 PTA 治疗与球孢子菌性脑膜炎相关的血管痉挛的病例。当血管痉挛具有临床症状时，PTA 是一种安全且可行的治疗方法。
