Cryptococcal meningoencephalitis with fulminant intracranial hypertension: an unexpected cause of brain death

Teo YK
Correspondence: Dr Yeow Kwan Teo, jimdel@singnet.com.sg

ABSTRACT
The diagnosis of brain death requires the presence of unresponsiveness and a lack of receptivity, the absence of movement, breathing and brain stem reflexes, as well as a state of coma in which the cause has been identified. We report a case of brain death that was diagnosed based on clinical neurological examinations, and supported by the absence of cerebral blood flow on magnetic resonance angiography and electroencephalography demonstrating the characteristic absence of electrical activity. Thorough clinical examination and repeated imaging of the brain revealed no apparent clinical cause or mechanism of brain death. We proceeded with organ donation of the deceased’s liver and corneas. However, postmortem revealed Cryptococcus neoformans meningoencephalitis as the cause of irreversible coma.

Keywords: brain death, cryptococcal meningoencephalitis, electroencephalography, intracranial hypertension, magnetic resonance angiography
Singapore Med J 2010; 51(8): e133-e136