Cuellar-Hernandez J Javier, Seañez Carlos, Olivas-Campos Ramon, Chavez Rodrigo, Tabera-Tarello Paulo M, Serna-Roman B Manuel
Department of Neurosurgery, Swiss Hospital, Monterrey, Mexico.
Department of Neurosurgery, Northeast National Medical Center, Monterrey, Mexico.
Surg Neurol Int. 2021 Apr 19;12:167. doi: 10.25259/SNI_65_2021. eCollection 2021.
has a tropism for the nervous system with a higher prevalence of infection in immunosuppressed patients; it remains a major cause of human immunodeficiency virus (HIV)-related mortality worldwide. Neurological compromise caused by this microorganism mainly debuts as a meningeal syndrome, spinal involvement has been reported in literature, neuropathological assessments have found Cryptococci in spinal roots and meninges, with perineuritic adhesions probably explaining compromise lower cranial nerves and even spinal nerve roots.
39-year-old male seronegative for HIV, with a surgical history of hydrocephalus treated with ventriculoperitoneal shut 1 year before, he presented with progressive weakness in the four extremities evolving to be disabling with bilateral accessory nerve palsy and loss of sensation below his neck. The MR imaging showed diffuse leptomeningeal thickening both supra and infratentorial and over the spinal canal up to C5 with a cystic formation shown in the craniocervical union causing compression of the medullary bulb. The patient underwent a medial suboccipital craniectomy with resection of the posterior arch of c1 for sampling and decompression, pathologically appears numerous spherical organisms that have a thick clear capsule and are surrounded by histiocytes forming a granuloma compatible with . Postoperatively, the patient's prior neurological deficits resolved.
It is an infrequently suspected pathology in immunocompetent patients, usually requiring only antifungal treatment with adjustment of immunosuppressive or antiretroviral management. In special and rare situations like our case as presenting with lower cranial nerve and spinal involvement, surgical treatment is a priority for the resolution of the pathology and improves disabling neurological deficit.
对神经系统具有嗜性，在免疫抑制患者中感染率较高；它仍然是全球人类免疫缺陷病毒（HIV）相关死亡的主要原因。这种微生物引起的神经功能损害主要表现为脑膜综合征，文献中已报道有脊髓受累，神经病理学评估在脊髓神经根和脑膜中发现隐球菌，神经炎周围粘连可能解释了较低颅神经甚至脊髓神经根的损害。
一名39岁男性，HIV血清学阴性，有脑积水手术史，1年前接受脑室腹腔分流术治疗，现出现四肢进行性无力，发展为双侧副神经麻痹并伴有颈部以下感觉丧失，导致残疾。磁共振成像显示幕上和幕下以及椎管至C5水平的软脑膜弥漫性增厚，颅颈交界处有囊性形成，压迫延髓。患者接受了枕下内侧颅骨切除术，切除C1后弓进行取样和减压，病理检查发现大量球形生物体，其有厚而清晰的包膜，周围有组织细胞形成与……相符的肉芽肿。术后，患者先前的神经功能缺损得到缓解。
在免疫功能正常的患者中，这是一种很少被怀疑的病理情况，通常仅需抗真菌治疗，并调整免疫抑制或抗逆转录病毒治疗。在像我们的病例这样出现较低颅神经和脊髓受累的特殊罕见情况下，手术治疗是解决该病理问题的首要措施，并可改善致残性神经功能缺损。
