Etiologies of leptomeningeal enhancement include: infection (viral, bacterial, or fungal), sarcoid, or neoplastic (lymphoma or carcinomatous).

In this case patient had a spinal tap and CSF demonstrated: (reference range)

• Color/appearance: Colorless, clear
• WBC: High 89 (0-10/UL)
• RBC: 12
• Neutrophils: High 11% (0-6%)
• Lymphocytes: High 86% (40-80%)
• Monocytes: Low 3% (15-45%)
• Glucose: 49 (40-70 MG/DL)
• Total Protein: High 118 (15-45 MG/DL)
• Gram Smear: No Cells Seen
• VDRL: nonreactive
• Indian Ink and Culture: Positive for C. neoformans.

The patient was diagnosed with Cryptococcal meningitis. There was no known history of HIV. The patient was also found to have a small left PICA infarct likely secondary to vacuities/spasm.