Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature
Introduction. Cryptococcal meningitis (CM) frequently associates immunocompromised patients, specifically in HIV infection, and it has high mortality. Neuro-ophthalmic manifestations are rare in patients with CM, especially internuclear ophthalmoplegia (INO) or wall-eyed bilateral internuclear ophth...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2025
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/44952 |
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I10-R327-article-44952 |
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Universidad Nacional de Córdoba |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Inglés |
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Artículo revista |
| topic |
cryptococcus cryptococcosis meningitis ophthalmoplegia visual pathway en cryptococcus criptococosis meningitis oftalmoplejía vías visuales en cryptococcus criptococose meningite oftalmoplegia vias visuais en |
| spellingShingle |
cryptococcus cryptococcosis meningitis ophthalmoplegia visual pathway en cryptococcus criptococosis meningitis oftalmoplejía vías visuales en cryptococcus criptococose meningite oftalmoplegia vias visuais en Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Argüelles-González, Eduardo Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| topic_facet |
cryptococcus cryptococcosis meningitis ophthalmoplegia visual pathway en cryptococcus criptococosis meningitis oftalmoplejía vías visuales en cryptococcus criptococose meningite oftalmoplegia vias visuais en |
| author |
Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Argüelles-González, Eduardo Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. |
| author_facet |
Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Argüelles-González, Eduardo Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. |
| author_sort |
Solís-Gómez, Raymundo |
| title |
Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| title_short |
Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| title_full |
Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| title_fullStr |
Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| title_full_unstemmed |
Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature |
| title_sort |
internuclear ophthalmoplegia as rare initial presentation cryptococcal meningitis: a case report and review of literature |
| description |
Introduction. Cryptococcal meningitis (CM) frequently associates immunocompromised patients, specifically in HIV infection, and it has high mortality. Neuro-ophthalmic manifestations are rare in patients with CM, especially internuclear ophthalmoplegia (INO) or wall-eyed bilateral internuclear ophthalmoplegia (WEBINO), most of them the result of secondary vasculitis. Case report. A 53-year-old woman with chronic hepatic failure, had sudden drowsiness, diplopia, fever, and internuclear ophthalmoplegia. MRI showed generalized leptomeningeal enhancement plus infratentorial nodular enhancement type in the midbrain and left cerebellar hemisphere. An India ink test was positive for Cryptococcus neoformans. Conclusion. Cryptococcal meningitis causes a wide spectrum of neurological manifestations, but neuro-ophthalmological signs are infrequent. Physicians should consider that these meningitis events are capable of generating symptoms due to intra-axial involvement of the Central Nervous System (CNS) due to vasculitis. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2025 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/44952 |
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I10-R327-article-449522025-03-31T17:43:07Z Internuclear Ophthalmoplegia as Rare Initial Presentation Cryptococcal Meningitis: A Case Report and Review of Literature Oftalmoplejía internuclear bilateral como rara presentación inicial de meningitis criptocócica: Reporte de caso y revisión de la literatura Oftalmoplejía internuclear bilateral como rara apresentação inicial de meningite criptocócica: Relato de caso e revisão da literatura Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. Argüelles-González, Eduardo Solís-Gómez, Raymundo Hernández-Dehesa, Itzel A. Adan-Ruiz, Aztlani Sánchez-Cruz, Adrián F. cryptococcus cryptococcosis meningitis ophthalmoplegia visual pathway en cryptococcus criptococosis meningitis oftalmoplejía vías visuales en cryptococcus criptococose meningite oftalmoplegia vias visuais en Introduction. Cryptococcal meningitis (CM) frequently associates immunocompromised patients, specifically in HIV infection, and it has high mortality. Neuro-ophthalmic manifestations are rare in patients with CM, especially internuclear ophthalmoplegia (INO) or wall-eyed bilateral internuclear ophthalmoplegia (WEBINO), most of them the result of secondary vasculitis. Case report. A 53-year-old woman with chronic hepatic failure, had sudden drowsiness, diplopia, fever, and internuclear ophthalmoplegia. MRI showed generalized leptomeningeal enhancement plus infratentorial nodular enhancement type in the midbrain and left cerebellar hemisphere. An India ink test was positive for Cryptococcus neoformans. Conclusion. Cryptococcal meningitis causes a wide spectrum of neurological manifestations, but neuro-ophthalmological signs are infrequent. Physicians should consider that these meningitis events are capable of generating symptoms due to intra-axial involvement of the Central Nervous System (CNS) due to vasculitis. Introducción. La meningitis criptocócica (MC) se asocia frecuentemente a pacientes inmunocomprometidos, específicamente en infección por VIH, con una alta mortalidad. Las manifestaciones neurooftálmicas son raras en pacientes con CM, especialmente la oftalmoplejía internuclear (INO) o la oftalmoplejía internuclear bilateral (WEBINO), la mayoría de ellas como resultado de vasculitis secundaria. Reporte de caso. Mujer de 53 años con insuficiencia hepática crónica, presentó somnolencia repentina, diplopía, fiebre y oftalmoplejía internuclear. La resonancia magnética mostró un realce leptomeníngeo generalizado más un realce nodular infratentorial en el mesencéfalo y el hemisferio cerebeloso izquierdo. Una prueba con tinta china dio positivo para Cryptococcus neoformans. Conclusión. La meningitis criptocócica causa un amplio espectro de manifestaciones neurológicas, pero los signos neurooftalmológicos son infrecuentes. Los médicos deben considerar que estos eventos de meningitis son capaces de generar síntomas por afectación intraaxial del Sistema Nervioso Central (SNC) por vasculitis. Introdução. A meningite criptocócica (MC) associa frequentemente pacientes imunocomprometidos, especificamente na infecção pelo HIV, e apresenta alta mortalidade. As manifestações neuro-oftálmicas são raras em pacientes com MC, especialmente a oftalmoplegia internuclear (INO) ou a oftalmoplegia internuclear bilateral do olho de parede (WEBINO), a maioria delas resultante de vasculite secundária. Relato de caso. Mulher de 53 anos, com insuficiência hepática crônica, apresentou sonolência súbita, diplopia, febre e oftalmoplegia internuclear. A ressonância magnética mostrou realce leptomeníngeo generalizado mais realce nodular infratentorial no mesencéfalo e hemisfério cerebelar esquerdo. Um teste em tinta nanquim foi positivo para Cryptococcus neoformans. Conclusão. A meningite criptocócica causa um amplo espectro de manifestações neurológicas, mas os sinais neuro-oftalmológicos são pouco frequentes. Os médicos devem considerar que esses eventos de meningite são capazes de gerar sintomas devido ao envolvimento intra-axial do Sistema Nervoso Central (SNC) devido à vasculite. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2025-03-31 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/44952 10.31053/1853.0605.v82.n1.44952 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 82 No. 1 (2025); 176-187 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 82 Núm. 1 (2025); 176-187 Revista da Faculdade de Ciências Médicas de Córdoba; v. 82 n. 1 (2025); 176-187 1853-0605 0014-6722 10.31053/1853.0605.v82.n1 eng https://revistas.unc.edu.ar/index.php/med/article/view/44952/48674 https://revistas.unc.edu.ar/index.php/med/article/view/44952/48610 Derechos de autor 2025 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |