Teaching NeuroImage: Cryptococcosis in the Central Nervous System Mimicking Neurocysticercosis

A 51-year-old man presented with headache, paresthesias of the legs and arms, and seizure. MRI showed multiple cystic lesions with dot sign and gadolinium enhancement (Figures 1 and 2). The findings are reported to be pathognomonic of neurocysticercosis in the colloidal stage; however, brain tumors and cryptococcosis can mimic it. In this case, Cryptococcus gattii was isolated from the CSF. Despite treatment with amphotericin B and fluconazole, the patient died. There are important imaging differences between neurocysticercosis and cryptococcosis. In neurocysticercosis, usually there is no postcontrast enhancement of the dot sign. Cryptococcosis encephalitis is a difficult-to-treat disease that can affect immunosuppressed or immunocompetent patients.1,2