Crescendo Transient Ischemic Attacks Due to Basilar Coccidioidal Meningitis With Coccidioma

Carlos D'Assumpcao; Arash Heidari; Katayoun Sabetian; Royce H Johnson

doi:10.1177/2324709618813178

Crescendo Transient Ischemic Attacks Due to Basilar Coccidioidal Meningitis With Coccidioma

J Investig Med High Impact Case Rep. 2018 Nov 19:6:2324709618813178. doi: 10.1177/2324709618813178. eCollection 2018 Jan-Dec.

Authors

Carlos D'Assumpcao^{1

2}, Arash Heidari^{1

3}, Katayoun Sabetian¹, Royce H Johnson^{1

3}

Affiliations

¹ Kern Medical-UCLA, Bakersfield, CA, USA.
² Ross University, Miramar, FL, USA.
³ Valley Fever Institute, Bakersfield, CA, USA.

Abstract

Coccidioidal meningitis typically presents with symptoms that may include headache, altered mental status including personality changes, fever, nausea, vomiting, gait abnormalities, and focal neurological deficits. This is a case of coccidioidal meningitis that initially presented as 4 consecutive crescendo cerebrovascular transient ischemic attacks with focal neurological deficits that resolved within minutes. Imaging showed a left basilar coccidioma. Follow-up at 4 months showed treatment response to conservative therapy of fluconazole 1000 mg with a dexamethasone taper. Crescendo cerebrovascular transient ischemic attacks are a unique initial presentation of coccidioidal meningitis.

Keywords: coccidioidal meningitis; coccidioidomycosis; crescendo transient ischemic attack.