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Título

PARKINSONISM SECUNDARY TO NEUROINFECTION: A FUNCTIONAL LOBECTOMY BY NEUROCRYTOCOCCOSIS

RESUMO

CASE REPORT: A previously healthy 39 year-old patient started with progressive emotional lability, loss of appetite and hyporexia, associated with a depressive status 2 years ago. The case was initially associated with functional limitation. 12 months ago the initial symptoms worsened, and intermittent holocranial headaches with tremors, slow and clumsy member movements were associated. They were admitted in a specialized service for investigation. A parkinsonian syndrome was detected in the physical examination: plastic hypertonism, bradykinesia, with rest and postural bilateral, symmetric, high frequency and low amplitude tremors of the extremities. Hypomimia, cognitive loss with an amnestic component and bradypsiquism were also found. Routine laboratorial investigation showed no findings. HIV, syphilis and hepatitis serologies were negative, with normal levels of TSH and T4. CSF: OP 19 cmH20 – Erythrocytes 250; white cells 100 (Lymph 86 | Neutro 15 | Mon 9), Glu 42; Ptn 262; negative acid-fast stain; negative Gram stain; general culture results were also negative. A rapid test for Cryptococcus neoformans was positive. Cranial MRI showed a T1 hypointensity signal and a T2 and FLAIR hyperintensity signal in the bilateral nuclear-capsular region, somewhat symmetric. There was also a post-contrast enhancement of these multiple confluent nodular points, with compromise of the ependyma of the lateral ventricles, III and IV ventricles and the basal cisternal leptomeningeal layer. With the diagnose of neurocryptococcosis in mind, treatment started with Amphotericin B, Fluconazole and inicial fase corticostheroids, which were later associated with Prolopa and Levetiracetam, with substantial improvement of the bradykinesia and bradypsiquism. Ambulatorial follow-up is being made to this day.
DISCUSSION AND FINAL CONSIDERATIONS: Secundary parkinsonian syndromes are frequently associated with vascular diseases or drug usage, but other differential diagnoses include post-cranial cerebral trauma, neuroinfections, encephalitis, external intoxications and multiple sclerosis. This particular case stood out because of the low frequency of Parkinson syndrome secondary to a neuroinfection; specially a non-HIV infected patient suffering from neurocryptococcosis.

Palavras Chave

NEUROCRYPTOCOCOSIS; PARKINSONISM; NEUROINFECTION; CEREBRAL NEUROCRYPTOCOCOMA.