Document 0247
 DOCN  M9590247
 TI    Cryptococcal meningitis complicated by superior saggital sinus
       thrombosis.
 DT    9509
 AU    Hale GE; Merrell WH; John Hunter Hospital, NSW.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:277 (unnumbered poster).
       Unique Identifier : AIDSLINE ASHM6/95291852
 AB    A 27 year old patient presented with Cryptococcal Meningitis as an HIV
       presenting illness. There was a three month history of 10kg weight loss
       and recurrent chest infections. Three days prior to admission, the
       patient was noted to be intermittently drowsy and disorientated. On
       presentation, the patient was semicomatosed with no neck stiffness or
       focal neurological signs. A CSF examination revealed a positive India
       Ink stain, 10WBC, Glucose 1.3, Protein 0.42. The opening pressure was
       normal. Intravenous amphotericin B and flucytosine were commenced. The
       patient's conscious state had returned to normal by day 2. On day 3
       however, multiple generalised seizures were observed. A left hemiplegia
       was noted initially, followed several hours later by a dense right
       hemiplegia. There was some recovery of left arm function. Bulbar
       function and speech were preserved. A CT brain scan on day 1 was normal
       but on day 4 revealed generalised oedema. On day 7, a repeat CSF
       examination revealed an unmeasurably high opening pressure. The
       cryptococcal culture and India Ink stain remained positive. On day 12 an
       MRI revealed Bilateral Saggital Sinus Thrombosis with extensive venous
       infarction and areas of haemorrhage. There was little neurological
       change until coma and death on day 17. There have been no other reports
       in the literature of this complication of cryptococcal meningitis in
       AIDS. We present the MRI findings and review the incidence and features
       of Superior Saggital Sinus Thrombosis.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS  Case Report
       Cerebral Hemorrhage/DIAGNOSIS  Cerebral Infarction/DIAGNOSIS  Human
       Magnetic Resonance Imaging  Male  Meningitis, Cryptococcal/*DIAGNOSIS
       Neurologic Examination  Sinus Thrombosis/*DIAGNOSIS  Tomography, X-Ray
       Computed  MEETING ABSTRACT

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