Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms
Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms
复制标题
DOI：
10.1007/s002340050717
复制
发表时间：
1999-02-01
期刊：
影响因子：
2.8
通讯作者：
Lanfermann, H
中科院分区：
文献类型：
--
作者：
Berkefeld, J;Enzensberger, W;Lanfermann, H
1例新型隐球菌感染患者的CT和MRI表现为类似肉芽肿或脓肿的增强型实质病变。在没有对比增强的初始阶段后，在2周内可见病变的全部范围。增强肿块被认为是脑内隐球菌瘤。尽管脑脊液（CSF）检查有大量脑膜感染的证据，但未显示脑膜炎、Virchow-Robin间隙侵入或脑室炎的放射学体征。经抗真菌治疗后，增强消失，囊变、部分钙化灶保留。在这个阶段，没有放射学相关性的脑膜感染复发是明显的。在第二例确诊的隐球菌性脑膜炎中，邻近脑实质的Virchow-Robin间隙或囊肿扩张是MRI的主要异常。未检测到增强肿块。这些病例可能代表了免疫功能低下的宿主对C.新生儿：血管周围间隙的增宽与更典型的脑膜感染相关，而增强的实质病变是CSF间隙进一步侵入的迹象。隐球菌瘤的增强，表明周围脑的炎症反应，在免疫功能受损的患者中并不典型。
CT and MRI in one case of Cryptococcus neoformans infection showed contrast-enhancing parenchymal lesions resembling granulomata or abscesses. After an initial phase without contrast enhancement, the full extent of the lesions was visible within 2 weeks of presentation. The enhancing masses were assumed to represent intracerebral cryptococcomas. Despite evidence of massive meningeal infection on cerebrospinal fluid (CSF) examination, no radiological signs of meningitis, invasion of the Virchow-Robin spaces or ventriculitis could be demonstrated. With antimycotic treatment the contrast enhancement disappeared and cystic, partly calcified lesions remained. Recurrence of meningeal infection without radiological correlates was apparent in this stage. In a second case of proven cryptococcus meningitis, dilation of Virchow-Robin spaces or cysts in the adjacent parenchyma were the main abnormalities on MRI. Enhancing masses were not detected. These cases may represent two different reactions of the immunocompromised hosts to infection with C. neoformans: widening of the perivascular spaces as a correlate of the more typical meningeal infection and enhancing parenchymal lesions as a sign of further invasion from the CSF spaces. Enhancement of cryptococcomas, indicating an inflammatory response in the surrounding brain, is not typical in patients with impairment of immune function.