Involuntary Movement Disorders in Central Nervous System Fungal Infections: A Systematic Review.

BACKGROUND

Central nervous system fungal infections, though rare, may lead to various movement disorders either due to direct fungal invasion or as adverse effects of antifungal drugs.

OBJECTIVES

This systematic review aimed to consolidate all published cases and characterize the clinical patterns, mechanisms, and outcomes.

METHODS

A systematic review was conducted in line with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251088348). Published case reports, series, and cohorts describing movement disorders in CNS fungal infections were identified from PubMed, EMBASE, Scopus, and Google Scholar.

RESULTS

Forty-five studies with 50 cases were included. Movement disorders directly attributed to fungal infection (n = 22; 44%) occurred predominantly in males (86.4%) with a mean age of 48 years. The most common pathogens were Cryptococcus neoformans (68.2%) and Coccidioides (13.6%). Chorea (45.5%), parkinsonism (27.3%), and tremor (13.6%) were frequent. Basal ganglia involvement was seen in 77.3% of patients. Antifungal drugs used included amphotericin B (77.3%), fluconazole (50%), and flucytosine (54.5%). Outcomes included full recovery (18.2%), partial improvement (36.4%), persistent symptoms (22.7%), and death (22.7%). Drug-induced movement disorders (n = 11; 22%) were linked mainly to amphotericin B (81.8%), with tremor (45.5%), myoclonus (18.2%), and dystonia (18.2%). Mortality was 45.5%. Ataxia with cerebellar involvement (n = 17; 34%) presented as gait (58.8%), truncal (29.4%), or limb ataxia (17.6%), with cerebellar abscesses (52.9%) and leptomeningeal enhancement (23.5%) on imaging. Recovery occurred in 64.7%, while 17.6% died.

CONCLUSION

CNS fungal infections can lead to diverse variety of movement disorders. Early recognition of clinical patterns and neurotoxic drug effects is essential for optimal management.