Cryptococcal Meningitis Causing Refractory Hemichorea-Hemiballismus Treated With Pallidotomy

Kevin G Buell; Brian P Vickers; Karen C Bloch; Amy E Brown; Peter Hedera; Walter Jermakowicz; Peter E Konrad; E Wesley Ely

doi:10.7759/cureus.16493

Cryptococcal Meningitis Causing Refractory Hemichorea-Hemiballismus Treated With Pallidotomy

Cureus. 2021 Jul 19;13(7):e16493. doi: 10.7759/cureus.16493. eCollection 2021 Jul.

Authors

Kevin G Buell¹, Brian P Vickers¹, Karen C Bloch², Amy E Brown³, Peter Hedera⁴, Walter Jermakowicz⁵, Peter E Konrad⁵, E Wesley Ely^{6

7}

Affiliations

¹ Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
² Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, USA.
³ Department of Neurology, Vanderbilt University Medical Center, Nashville, USA.
⁴ Department of Neurology, University of Louisville, Louisville, USA.
⁵ Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, USA.
⁶ Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center; and Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA.
⁷ Geriatric Research Education Clinical Center, Tennessee Valley Veteran's Affairs, Nashville, USA.

Abstract

We report a case of a 31-year-old immunocompetent male who presented with altered mental status and agitation requiring intubation. As sedation was weaned, he demonstrated choreiform movements with associated hemiballismus of the right upper and lower extremities, and he was ultimately diagnosed with cryptococcal meningitis. The patient's chorea did not terminate after the completion of induction antifungal therapy and all pharmacologic options for the management of chorea were ineffective. He underwent a successful unilateral pallidotomy using standard stereotactic methodology targeting the posterior-ventral pallidum, and his choreiform movements dramatically improved post-operatively within 48 hours.

Keywords: cryptococcal meningitis; cryptococcus neoformans; hemiballismus; hemichorea; pallidotomy.

Publication types

Case Reports

Grants and funding

Dr. Eugene W. Ely has received grant funding from the National Institute of Aging (R01-AG058639). The funding institutions had no role in the conception, design, or conduct of this report, data collection, management, analysis, interpretation, or presentation of the data; preparation, review, or approval of the manuscript; or the decision to submit for publication.