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J Korean Neurosurg Soc. 1976 Jun;5(1):157-162. Korean. Original Article.
Kim JM , Choi DY , Rhim KS .
Department of Neurosurgery, Chung-Ang University, College of Medicine, Seoul, Korea.

Cryptococcosis is the most common form of fungal infection of the central nervous system, which is classified as meningeal, embolic and perivascular type. Cryptococcal meningitis and meningo-encephalitis are not infrequent, but the only 40 cases of localized torula granuloma in the central nervous system had been reported in the worldwide literature until 1973 since the first reports of LeCount and Myers in 1907. Our new case reported here, a thirty-eight tear old female patient was admitted to our department because of abruptly appeared headache with nausea and vomiting, drowsy mental state and left hemiparesis. On admission the left hemiparesis and remarkable meningeal irritation signs were found. Chest film and skull films showed no evidence of abnormality. The right carotid angiogram revealed the shifting of the anterior cerebral artery to the left side with concomittant U-loop widening (Fig-1), Sylvian triangle displaced posteriorly, closed carotid siphon(Fig. 2) and abnormal draining vessels with staining on the frontal base of cerebrum (Fig. 1,2,3,4). Examination of the cerebrospinal fluid showed remarkable polymorphonuclear leucocyte predominant pleocytosis, elevated protein and normal sugar content. And negative smear for cryptococci and other microorganisms. A right frontal craniotomy and brain exploration exposed grayish gelatinous mass of about 3.5cm in diameter, which was partially removed. Microscopic findings were acute and chronic inflammatory changes in different stages with various types of giant cells and cryptococci (Fig. 5,6). On the third postoperative day, the patient died. Neither amphotericin-B nor 5-Fluorocytosine was administered because preoperative diagnosis was tumor, and postmortem examination couldn't be done.

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