Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(06): 384
DOI: 10.1590/0004-282X20200015
Images in Neurology

Hippocampal sclerosis in paracoccidioidomycosis

Esclerose hipocampal na paracoccidioidomicose
Marcos ROSA-JÚNIOR 
1   Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio de Moraes, Departamento de Neurorradiologia, Vitória ES, Brazil.
,
Mariana Lacerda Reis GRENFELL
2   Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio de Moraes, Departamento de Neurologia, Vitória ES, Brazil.
,
Paulo Mendes PEÇANHA 
3   Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antônio de Moraes, Departamento de Doenças Infecciosas, Vitória ES, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

A 39-year-old man presented with complex partial seizures five years after treatment of central nervous system (CNS) paracoccidioidomycosis (PCM). Post-treatment images showed reduction of the CNS lesions and appearance of hippocampal sclerosis (HS) ([Figures 1] and [2]). To the best of our knowledge, this is the first description between PCM and HS.

Zoom Image
Figure 1 (A) and (B) - T2WI and FLAIR show lesions with low T2WI signal (white arrows) with vasogenic edema. Note the normal hippocampi (red arrows). (C) - T1 post-contrast shows lesions with annular enhancement (white arrows). (D) - chest CT with cavitated lesions.
Zoom Image
Figure 2 (A) (FLAIR) and (B) (T1 post-contrast) - show lesion resolution and encephalomalacia after treatment (white arrows). (C) and (D) T2 and FLAIR - show volumetric reduction, signal hyperintensity and loss of internal architecture of the left hippocampus (red arrows) - HS.

HS is a common pathological finding in temporal lobe epilepsy[1]. The etiology is controversial, whether acquired or developmental, however triggering factors of HS can be epilepticus status, febrile seizures, infectious and vascular diseases or malformations. When associated with other diseases, as in this case of PCM[2],[3], it is called dual pathology.



Publication History

Received: 08 January 2020

Accepted: 27 January 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Liu Z, Mikati M, Holmes GL. Mesial temporal sclerosis: pathogenesis and significance. Pediatr Neurol. 1995 Jan;12(1):5-16. https://doi.org/10.1016/0887-8994(94)00122-i
  • 2 Rosa Júnior M, Baldon IV, Amorim AC, Melo AFC, Peçanha P, Falqueto A, et al. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol. 2018 Jun;103:147-62. https://doi.org/10.1016/j.ejrad.2018.03.026
  • 3 Rosa Júnior M, Amorim AC, Baldon IV, Martins RM, Pereira RP, Campos SS, et al. Paracoccidioidomycosis of the Central Nervous System: CT and MR imaging findings. AJNR Am J Neuroradiol. 2019 Oct;40(10):1681-8. https://doi.org/10.3174/ajnr.A6203