Kondo H, Yamamoto K, Kubo H, Hosino M, Okayama K
Department of Neurology, Ohmiya Red Cross Hospital.
Rinsho Shinkeigaku. 1995 Apr;35(4):373-8.
The patient was a 35-year-old man with confusional state and headache. Analysis of cerebrospinal fluid (CSF) showed 1,383/mm3 cell count, the protein level of 300mg/dl and glucose level of 42 mg/dl. Cryptococcus neoformans was disclosed by India ink preparation. The cryptococcal antigen test was positive at 1:125 by latex agglutination. The diagnosis of cryptococcal meningoencephalitis was determined. Antifungal treatment with amphotericin B resulted in improvement of neurologic signs, CSF findings and cryptococcal antigen test. But two months later, brain MRI demonstrated low intensity areas on T1 weighted image and high intensity areas on T2 and proton weighted images in the cerebral cortical region. Gd-DTPA MRI showed enhanced areas in the cerebral leptomeninges. It was considered that these MRI lesions corresponded to pseudocysts and Gd-DTPA enhanced lesion indicated dilated vessels or destructed blood-brain barrier. After administration of larger doses of amphotericin B, these lesions on MRI disappeared. It is suggested that brain MRI is useful in diagnosis of cryptococcal meningoencephalitis to detect pseudocysts at the cortical region which may imply the early stage of procrastinating process.
患者为一名35岁男性，伴有意识模糊状态和头痛。脑脊液（CSF）分析显示细胞计数为1383/mm³，蛋白水平为300mg/dl，葡萄糖水平为42mg/dl。墨汁负染法发现新型隐球菌。乳胶凝集法检测隐球菌抗原，结果为1:125阳性。确诊为隐球菌性脑膜脑炎。使用两性霉素B进行抗真菌治疗后，神经体征、脑脊液检查结果及隐球菌抗原检测均有所改善。但两个月后，脑部MRI显示大脑皮质区域在T1加权像上呈低信号区，在T2加权像和质子加权像上呈高信号区。钆喷酸葡胺增强MRI显示软脑膜有强化区域。认为这些MRI病变对应于假性囊肿，钆喷酸葡胺增强病变提示血管扩张或血脑屏障破坏。给予更大剂量的两性霉素B后，MRI上的这些病变消失。提示脑部MRI有助于隐球菌性脑膜脑炎的诊断，可检测皮质区域的假性囊肿，这可能意味着病情迁延的早期阶段。
