MRI findings of cryptococcal infection of CNS: The long term follow-up: case report

Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.

MRI findings of cryptococcal infection of CNS: The long term follow-up: case report

Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.

Computed tomographic evaluation on ossification of posterior longitudinal ligament and ligamentum flavum ofspine

Ossification and calcification of the spinal ligaments frequently cause pressure upon the spinal cord andnerve roots. Authors reviewed 150 cases of C-spine CT, 80 cases of T-spine CT, and 725 cases of L-spine CT whichwere carried out a Pusan Natina University Hospital for 2 years from May 1983 to May 1985. We analysed 34 caseswhich showed ossification of posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF) of these 955cases. The results are follows: 1. The male ot female ratio of spinal ligamentous ossification was 26:8. The 5thdecade group (24.41%) was the most prevalent age group. 4th decade(26.4%), 6th decade(23.52%), 7th decade(11.76),3rd decade (8.8%), and 8th decade(2.94%) in that order. 2. Of 955 cases of spine CT, the incidence of OPLL was 25cases(21.51%) and that of OLF was 10 ases(1.05%). 3. Regional incidence of spinal ligamentous ossification was asfollows. 1) In case of OPLL, cervical area was 19/150(12.67%) and lumbar area was 6/725 (0.83%). 2) In cases ofOLF, Thoracic area was 3/80(3.75%) and lumbar area was 8/725(1.10%). 4. The most frequent length of OPLL was 4body length (32%) and the most frequent locations are C4 and C5(68%). The types fo OPLL were 15 cases(60%) ofsegmental type, 8 cases(32%) of continuous type, and 2 cases(8%) of mixed type in that order. All segmental typeswere degree 1 or 2 and most continuous and mixed type (80%) were degree 2 or 3 dural sac effect. 5. The number ofinvolved interlaminar spaces in OLF was 1 to 5 interspaces and most of OLF were found at low thoracic and lumbararea. 6. There could be noted high correlation between the spinal ligamentous ossification and degenerative discdisease, The incidence of associated disc disease was 18/25(72%) in OPLL and 8/10(80%) in OLF.