Venous Sinus Dysplasia Masking the Diagnosis of Cryptococcal Meningitis

To the Editor: On November 12, 2015, a 63‐year‐old woman was referred to a local hospital with a 2‐week history of headache and vomiting. She described her headache as generalized and without photophobia or any other visual abnormalities. She was afebrile over the course of the disease. An examination of the cerebrospinal fluid (CSF) was performed 2 days after admission and revealed a white blood cell (WBC) count of 3.8 × 107 cells/L, intracranial pressure of 30 cmH2O (1 cmH2O = 0.098 kPa), normal biochemistry, and absence of Cryptococcus. Cranial magnetic resonance imaging showed a normal parenchymal image, and magnetic resonance venography (MRV) showed venous sinus dysplasia, possibly indicating left transverse sinus thrombosis [Figure 1a]. Other laboratory studies were unremarkable. However, her vision and hearing decreased within 3 weeks of admission.