2 Cases Of Cryptococcal Meningitis With Special Cranial Imaging Manifestations And Literature Review

Purpose: To investigate the clinical characteristics,imaging findings,treatment plan and prognosis of 2 cases of cryptococcal meningitis with bilateral basal ganglia high-density foci on CT plain scan,and to review the relevant literature at home and abroad retrospectively,so as to improve clinicians’ understanding of this disease.Method: The clinical manifestations,craniocerebral CT,cerebrospinal fluid examination,treatment and prognosis of the patients were analyzed by descriptive statistical methods.We also reviewed relevant literature to explore the possible causes of bilateral basal ganglia high density on CT.Result: A total of 2 cases of CT scan involving the basal ganglia region of high density focal cryptococcal meningitis cases,1 cases incidence after 4months for bilateral basal ganglia region in CT scan showed multiple nodular or class of circular stove with high density,the main symptoms are headache,hand shake,op,leading lung neoplasm resection,postoperative pathology confirmed for cryptococcus lesions,multiple cerebral CT found after bilateral basal ganglia region high density shadow,cultivate cryptococcus cerebrospinal fluid lines of lumbar puncture,to antifungal therapy symptoms improved,condition is not stable,over and over again in our hospital and local hospital for treatment,after more than 1 year follow-up of patients with neurological symptoms improve earlier,cerebrospinal fluid results before improving,Brain CT indicated that the intracranial lesions were smaller than before;Cases of 2 patients with more than 20 days after onset row CT scan showed the right side of the basal ganglia,insula see multiple circular anomaly density(high edge density,low density),main symptoms are headache,chills,fever,nausea,vomiting,confusion,limb tic,right basal ganglia neoplasm resection in our hospital,postoperative pathology confirmed for cryptococcal granuloma,lumbar puncture found cryptococcus,continue to antifungal treatment for 6 months after cure.Multiple reexaminations after head CT surgery showed symmetrical patchy high-density shadows in bilateral basal ganglia.A review of the literature found that from 1990 to 2020,there was only one similar report of Cryptococcal meningitis manifested as high-density foci in basal ganglia region on plain CT scan at home and abroad.This case showed high-density lesions in the head of right caudate nucleus,left inner capsule,frontal lobe and occipital lobe on skull CT from 1990 to 2020.However,due to the age,relevant data were not available.Conclusion:(1)Cryptococcal meningitis can be manifested as bilateral high-density lesions in the basal ganglia region on brain CT,which may be the manifestation of cryptococcal chronic granuloma and calcification on CT,in addition,cryptococcal granulomas may present on CT as low-density lesions in basal ganglia.The intracranial lesions can be shrunk and the symptoms can be improved by antifungal treatment.(2)Surgical treatment is feasible when the mass effect of cryptococcal granuloma of the central nervous system is obvious.Postoperative pathological results are an important basis for diagnosis.The patient has a good prognosis when postoperative antifungal therapy is supplemented.