MR angiography of large-vessel intracranial stenosis after cryptococcal meningitis

We present a case of cryptococcal meningoencephalitis producing narrowing of both middle cerebral arteries on MRI/MRA, described in a 56-year-old man with a history of Wegener’s granulomatosis. Diagnosis was based on the presence of cryptococcal antigen in serum and CSF. Imaging performed seven months after initial presentation demonstrated thickened enhancing leptomeninges with focal inflammatory masses in the Sylvian fissures. To our knowledge, this striking appearance has not been previously demonstrated simultaneously on MRI/MRA.