NEUROLOGICAL ASPECTS OF CEREBRAL CRYPTOCO CCOSIS

Cryptococcal infection is the most common fungal infection of the cent ral nervous system. More than 50 % of the cases of cryptococcal infect ion are superimposed on an immunosupressive or other general debilatat ing condition. Cerebral cryptococcosis usually presents as meningitis or meningoencephalitis, although cerebral granuloma has also been repo rted. Hydrocephalus is the most common neurosurgical complication of c erebral cryptococcosis. The majority of patients require only medical treatment with antifungal drugs. However, when complications ensue, su rgical intervention is mandatory. We suggest that chronic meningitis b e ruled out in all patients prior to the placement of shunts. In the t wo cases reported here treatment of cryptococcal meningitis was a comb ination of amphotericin B and flucytosine for six weeks. Fluconazole i s a new alternative and at least as effective as amphotericin B.