What are the key radiological and clinical features of brain coccidioidomycosis, and how does it typically present in the central nervous system?

Brain coccidioidomycosis is most prevalent in the southwestern United States and is characterized by meningitis, which can lead to hydrocephalus. Focal parenchymal granulomas are rare but may appear as enhancing lesions on MRI. Key diagnostic features include basilar meningitis and hydrocephalus, often with elevated CSF protein and lymphocytic pleocytosis. Clinical pearls include considering coccidioidomycosis in patients with travel history to endemic areas presenting with chronic meningitis. Common pitfalls include mistaking it for tuberculosis or other fungal infections; serologic tests and CSF analysis can aid in differentiation.