Vasculitic Basilar Artery Thrombosis in Chronic Candida Albicans Meningitis

Cerebrovascular complications of meningitis have been most extensively documented in the setting of acute bacterial or chronic tuberculous meningitis. Involvement of major cerebral vessels is rare and basilar artery thrombosis has not been reported in fungal meningitis secondary to candida infection...

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Bibliographic Details
Published in:Canadian journal of neurological sciences 1998-02, Vol.25 (1), p.76-78
Main Authors: Grimes, D.A., Lach, B., Bourque, P.R.
Format: Article
Language:English
Subjects:
Adult
Basilar Artery - pathology
Biological and medical sciences
Candidiasis - complications
Candidiasis - pathology
Cerebral Infarction - etiology
Cerebral Infarction - pathology
Chronic Disease
Female
Human mycoses
Humans
Infectious diseases
Intracranial Embolism and Thrombosis - etiology
Intracranial Embolism and Thrombosis - pathology
Medical sciences
Meningitis, Fungal - complications
Meningitis, Fungal - pathology
Mycoses
Mycoses of the nervous system
Original Articles
Vasculitis - etiology
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Summary:Cerebrovascular complications of meningitis have been most extensively documented in the setting of acute bacterial or chronic tuberculous meningitis. Involvement of major cerebral vessels is rare and basilar artery thrombosis has not been reported in fungal meningitis secondary to candida infection. We describe the clinical course and neuropathological findings in a woman with chronic meningitis due to Candida albicans. The diagnosis remained elusive antemortem despite analysis of 7 large volume CSF samples and examination of a meningeal and cortical biopsy. Death followed extensive brainstem and temporo-occipital infarction secondary to basilar artery thrombosis. The basilar artery occlusion was secondary to an intense, granulomatous and necrotizing basal meningitis focally extending to the media and intima. This paroxysmal and devastating complication of untreated chronic candida meningitis reinforces that a trial of empirical therapy with both antituberculous and antifungal agents should be considered in most cases of chronic culture-negative lymphocytic meningitis.
ISSN:0317-1671
2057-0155
DOI:10.1017/S0317167100033539