Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Cryptococcal meningoencephalitis presenting with treatable cognitive impairment and involuntary movement

Kazuhiro Ikumi, M.D.1), Katsunori Yokoi, M.D.1) and Tetsuo Ando, M.D.1)

1)Department of Neurology, Anjo Kosei Hospital

The patient is a 72-year-old Japanese woman. Seven years prior to admission, multiple nodules in her left lung were found. Bronchoscopic biopsy of the nodules did not provide a confirmative diagnosis, and probable diagnosis of cryptococcosis was made. Follow-up CT scan of the chest revealed reduction in size of the lung nodules. She was admitted to our hospital due to progressive cognitive impairment and difficulty in walking that lasted for 5 months. On admission, athetotic involuntary movement was observed in her lower extremities, predominantly in the right side. Blood and cerebrospinal fluid culture of the patient were positive for Cryptococcus neoformans. Antifungal drugs resolved the cognitive impairment, the difficulty in walking, and the involuntary movement. We assessed the cognitive impairment and observed the clinical improvement of the patient, with the use of neuropsychological examinations. To our knowledge, there has been only a few reported case of cryptococcal meningoencephalitis presenting with treatable cognitive impairment and involuntary movement.
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Supplemental movie 1. Involuntary movement of the patient. The patient had involuntary movement in her lower extremities, predominantly in the right side. The involuntary movement was characterized by irregularly repeated extensionflexion and abduction-adduction of the toes, which resembled painful legs and moving toes although the patient did not have pain.
Full Text of this Article in Japanese PDF (510K)

(CLINICA NEUROL, 56: 27|31, 2016)
key words: cognitive impairment, involuntary movement, painful legs and moving toes, Cryptococcus neoformans

(Received: 8-Jul-15)