Abstract
A pseudo-subarachnoid hemorrhage (pseudo-SAH) is a brain computed tomography (CT) finding that is seen as high-density areas along the basal cisterns, the sylvian vallecula/fissure, the tentorium cerebella, or the cortical sulci, although no SAH is found upon lumbar puncture or at autopsy. There is one report of cryptococcal meningitis presenting as pseudo-SAH, but the explanatory pathology is unknown. A 68-year-old woman with headache, fever, decreased hearing, and decreased vision was admitted to our hospital. Cerebrospinal fluid India ink staining was positive, and culture yielded Cryptococcus neoformans. Cryptococcus meningitis was diagnosed. Head CT and magnetic resonance imaging (MRI) showed no abnormality upon admission, but 1 month later, head CT showed iso- to high-density areas within the sulci, and fluid-attenuated inversion recovery MRI showed high signal intensity within the convexity sulci resembling an SAH. These areas were enhanced by gadolinium on T1-weighted images. Lumber puncture produced no evidence of bleeding. Biopsy of the left frontal lobe sulci was performed, and histopathological study revealed inflammation and granulation with capsules of C. neoformans. The inflammation and granulation at the convexity sulci induced by the C. neoformans infection explained the pseudo-SAH in this case. Physicians should be aware that cryptococcal meningitis-induced inflammation and granulation at the sulci can present as pseudo-SAH on CT and MRI.
References
Jain KK, Mittal SK, Kumar S, Gupta RK (2007) Imaging features of central nervous system fungal infections. Neurol India 55:241–250
Yuzawa H, Higano S, Mugikura S, Umetsu A, Murata T, Nakagawa A, Koyama A, Takahashi S (2008) Pseudo-subarachnoid hemorrhage found in patients with postresuscitation encephalopathy: characteristics of CT findings and clinical importance. AJNR Am J Neuroradiol 29:1544–1549
Misra V, Hoque R, Gonzalez-Toledo E, Kelley RE, Minagar A (2008) Pseudo-subarachnoid hemorrhage in a patient with acute cerebellar infarction. Neurol Res 30:813–815
Rabinstein AA, Pittock SJ, Miller GM, Schindler JJ, Wijdicks EF (2003) Pseudosubarachnoid haemorrhage in subdural haematoma. J Neurol Neurosurg Psychiatry 74:1131–1132
Belsare G, Lee AG, Maley J, Kirby P, St Louis EK, Follett K (2004) Pseudo-subarachnoid hemorrhage and cortical visual impairment as the presenting sign of gliomatosis cerebri. Semin Ophthalmol 19:78–80
Chatterjee T, Gowardman JR, Goh TD (2003) Pneumococcal meningitis masquerading as subarachnoid haemorrhage. Med J Aust 178:505–507
Hoque R, Gonzalez-Toledo E, Jaffe SL (2008) Cryptococcal meningitis presenting as pseudosubarachnoid hemorrhage. South Med J 101:1255–1257
Avrahami E, Katz R, Rabin A, Friedman V (1997) CT diagnosis of non-traumatic subarachnoid haemorrhage in patients with brain edema. Eur J Radiol 28:222–225
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Nakae, Y., Kudo, Y., Yamamoto, R. et al. Pseudo-subarachnoid hemorrhage in cryptococcal meningitis: MRI findings and pathological study. Neurol Sci 34, 2227–2229 (2013). https://doi.org/10.1007/s10072-013-1461-2
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DOI: https://doi.org/10.1007/s10072-013-1461-2