Case of pseudo-subarachnoid hemorrhage in crytococcus meningitis

The authors report a case of a 68-year-old woman with cryptococcus meningitis found to have a pseudo-subarachnoid hemorrhage (SAH) on MRI.

She was admitted to the hospital with headache, fever, decreased hearing and decreased vision. Head computed tomography (CT) and MRI showed no abnormality upon admission, but one 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.

Lumbar 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 authors concluded that cryptococcal meningitis-induced inflammation and granulation at the sulci can present as pseudo-SAH on CT and MRI.