A flow chart proposed for early diagnosis of cryptococcal infection as a cause of stroke.

An 82-year-old woman had a transient ischemic attack and stroke of the left middle cerebral artery syndrome that turned out to be attributed to cryptococcal meningoencephalitis (CM). An initial presentation of central nervous system infection, such as fever and headache, was absent. It was masked by chronic use of corticosteroids and immunosuppressants for her rheumatoid arthritis. The diagnosis was made by the clinical setting of stroke-in-evolution and progression of hydrocephalus on the second brain imaging study. In this case, we discuss the atypical presentation of CM in an immunosuppressed patient and offer a flow chart for early diagnosis, thus improving outcome and survival rates.