amphotericin-b and Cerebral-Infarction

Neurological dysfunction as the first manifestation of AIDS has been found in 10 to 20% of symptomatic human immunodeficiency virus infections. However, stroke has rarely been reported in AIDS patients. The most common causes of cerebral infarction in AIDS are central nervous system infections: toxoplasmosis, cryptococcal meningitis and tuberculosis. Potential vascular mechanisms for cerebral infarction and transient neurological deficits among AIDS patients include deposition of antigen-antibody complexes with vasculitis and infarction, and a direct toxic effect of a viral antigen or infectious agent on vascular endothelium. The role of cryptococcal meningitis in vasculopathy is still not clear. We report a case of cerebral infarction in an HIV-infected patient, with cryptococcal meningitis as the first manifestation of AIDS.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cerebral Infarction; Fluconazole; Humans; Male; Meningitis, Cryptococcal; Tomography, X-Ray Computed

Cryptococcal infection constitutes around 3% of opportunistic infections in solid organ transplant recipients. Most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis (CME). Ischaemic stroke as a consequence of cryptococcal meningoencephalitisis rare and possibly due to the involvement of intracranial vessel by exudates causing vasculitis-related thrombosis. In this context, we describe an unusual case of asymptomatic cryptococcaemia in an RTR, progressing on to acute ischaemic stroke secondary to acute CME with near complete neurological recovery following timely diagnosis, early and appropriate antifungal treatment. The index case attempts to re-emphasise the significance of mandatory screening required to exclude the possibility of dissemination of cryptococcaemia in RTRs besides highlighting the requirement of prolonged induction phase with combination therapy, particularly in presence of stroke.

Topics: Aged; Amphotericin B; Antifungal Agents; Asymptomatic Diseases; Cerebral Infarction; Cryptococcus neoformans; Flucytosine; Humans; Immunocompetence; Kidney Transplantation; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Transplant Recipients

To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1DM).. The medical records of six patients of T1DM with ROCM admitted between October 2001 to January 2004 were analysed.. The mean (+/- SD) age and duration of DM of these patients were 16.1+/-3.0 years and 26.3 +/- 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.. High index of suspicion of ROCM in T1DM and combined approach with amphotericin B and appropriate surgery is rewarding.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Cerebral Infarction; Child; Diabetes Mellitus, Type 1; Fatal Outcome; Humans; Mucormycosis; Nose Diseases; Patient Compliance; Prognosis; Retrospective Studies

The authors describe the clinical course of Cryptococcus neoformans variety gattii infection in a young immunocompetent man who had a late deterioration characterized by headaches, subarachnoid inflammation, hydrocephalus, and stroke that reproducibly responded to steroids. These findings, in combination with declining markers of CSF infection, are consistent with the late deterioration being caused by sterile arachnoiditis rather than ongoing infection.

Topics: Acetazolamide; Adult; Amphotericin B; Antifungal Agents; Arachnoiditis; Cerebral Infarction; Dexamethasone; Disease Progression; Drug Therapy, Combination; Fluconazole; Flucytosine; Headache; Humans; Hydrocephalus; Immunocompetence; Male; Meningitis, Cryptococcal; Prednisone; Ventriculoperitoneal Shunt

A 20-year-old farmer who had headache and fever for 1 month, suddenly developed left hemiplegia, tremor in left arm and titubation followed by deep coma. Cranial CT scan revealed an infarction in right crus of midbrain. His CSF revealed 66 mg/dl protein, 10 lymphocytes/mm3, and 70 mg/dl glucose. CSF was positive for cryptococcal antigen. He improved following i.v. amphotericin 0.5 mg/kg and fluconazole 200 mg daily, continued for 6 and 12 weeks respectively. Infarctions though rare in cryptococcal meningitis should be considered in patients with chronic meningitis with vasculitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Cerebral Infarction; Chronic Disease; Fluconazole; Humans; Male; Meningitis, Cryptococcal; Mesencephalon; Tomography, X-Ray Computed

A 30-year-old male and a 40-year-old female presented with Aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.

Topics: Adult; Amphotericin B; Aspergillosis; Cavernous Sinus; Cerebral Infarction; Combined Modality Therapy; Craniotomy; Encephalitis; Fatal Outcome; Female; Hemiplegia; Humans; Male; Seizures