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Case Reports
. 2025 Feb 5;17(2):e78558.
doi: 10.7759/cureus.78558. eCollection 2025 Feb.

Relationship Between CNS Infections, Stroke, and Neurological Complications: A Case Series

Karan Soni  1 , Erin S Fannin  2 , Nojan Valadi  3
Affiliations
Case Reports

Relationship Between CNS Infections, Stroke, and Neurological Complications: A Case Series

Karan Soni et al. Cureus. .

Abstract

Central nervous system infections and complications such as meningitis and stroke in immunocompromised patients can be caused by a wide spectrum of pathogens, including bacteria, viruses, parasites, or fungi. This case series first presents a case of a 24-year-old Latino male patient with HIV, cytomegalovirus (CMV) encephalitis, a positive CSF for Coccidioides antigen, and a stroke, who presented to the primary care office with a headache and double vision. With his symptoms now occurring for more than two months without improvement, the patient was sent to the ED for a repeat MRI, where an enlargement of his ventricles compatible with hydrocephalus was observed. This patient was diagnosed with coccidioidal meningitis and sent to a different facility for neurosurgical management. The second case describes a 28-year-old White male patient living with HIV and struggling with polysubstance use, who presented to the ED with a stroke and encephalopathy. Labs to address his underlying cause of encephalopathy showed a positive rapid plasma reagin (RPR) titer, and MRI results were consistent with bilateral acute ischemic infarcts of syphilitic vs. HIV-associated vasculitis. The patient was placed on aspirin, corticosteroids, and high-dose antibiotics. A prognosis of coccidioidal meningitis and neurosyphilis can be fatal if left untreated; as a result, this case series emphasizes the need for prompt stroke management and workup, especially in the context of infection and/or encephalopathy. Discovering the underlying cause of stroke can not only address the patient's current symptoms but also prevent future stroke occurrence.

Keywords: central nervous system infections; coccidioidal meningitis; hiv; neurological complications; neurosyphilis; stroke.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI of the head in a patient with coccidioidal meningitis, demonstrating significant ventriculomegaly (arrow) and a complication of hydrocephalus
Figure 2
Figure 2. CT imaging of the head, demonstrating a right basal ganglia infarct (arrow), resulting in contralateral (left-sided) neurologic manifestations
See this image and copyright information in PMC

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