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Cryptococcus Meningitis with Refractory Hemichorea-Hemiballismus in an Immunocompetent Host: A Case Report and Review

Author(s): Kevin G. Buell MBBS*1, Brian P. Vickers MD1, Karen C. Bloch MD, MPH2, Amy E. Brown, MD, MS3, Peter Hedera, MD, PhD3, Walter Jermakowicz, MD PhD4, Peter E. Konrad MD, PhD, MS,4 E. Wesley Ely MD, MPH, FCCM5,6

Cryptococcal meningitis is most commonly diagnosed in patients with acquired immunodeficiency syndrome or other immunocompromising conditions. However, even in immunocompetent hosts, cryptococcus infection can disseminate to the central nervous system and cause devastating permanent neurologic deficits. Acquired hemichoreahemiballismus provoked by infection of the central nervous system is a rare complication resulting from the disruption of the normal inhibitory signals from the globus pallidus in the basal ganglia. We report the thirdcase of hemichorea-hemiballismus caused by cryptococcus meningitis in an immunocompetent 31-year old patient. After completing six weeks of induction antifungal therapy and exhausting all pharmacologic options for the treatment of his movement disorder, the patient underwent successful surgical pallidotomy for the management of cryptococcal meningitis induced hemichorea-hemiballismus.
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