Cerebral Venous Sinus Thrombosis Associated with Cryptococcal Meningitis in an HIV-Positive Patient

Abstract

Cryptococcal meningitis is one of the most common neurologic complications of AIDS. Cerebral venous sinus thrombosis is a rare cerebrovascular complication, usually associatied with HIV-related thrombosis, but infrequently reported on the setting of cryptococcal meningitis. The diagnostic method of choice for cerebral venous sinus thrombosis is magnetic resonance in combination with venography. Anticoagulation is usually not used in the setting of infectious thrombosis, but proved to be useful in this case. A 21 year-old Mexican man with recently diagnosed and untreated AIDS, presented with involuntary movements, headache, gait disturbances, and dysmetria. Cryptococcal meningitis was diagnosed and treated with amphotericin B and fluconazole, achieving some improvement. A week after diagnosis, the headache worsened and the imaging studies suggested a cerebral venous sinus thrombosis. The patient was started on non-fractionated heparin and he presented gradual recovery. He was followed-up for a year and did not present any recurrence or complication related to the thrombosis.