Imaging Spectrum of CNS Coccidioidomycosis: Prevalence and Significance of Concurrent Brain and Spinal Disease

OBJECTIVE. The purpose of this study was to evaluate the prevalence and significance of concurrent coccidioidal brain and intraspinal disease. MATERIALS AND METHODS. We conducted a retrospective imaging review of 23 patients with proven coccidioidal CNS meningitis. RESULTS. All patients had intracranial abnormalities, and 86% (19/22) who underwent spinal imaging had signs of intraspinal disease, including leptomeningeal enhancement (84%), arachnoiditis (63%), and cord signal abnormalities (37%); seven of 15 patients (47%) who underwent myelography had complete spinal blocks. CONCLUSION. The high prevalence of concurrent brain and intraspinal coccidioidomycosis supports a low threshold for spinal imaging.