The prognostic factors of HIV-negative adult cryptococcal meningitis with a focus on cranial MRI-based neuroimaging findings. (September 2018)

• Record Type: Journal Article
• Authors: Tsai, Wan-Chen; Lien, Chia-Yi; Lee, Jun-Jun; Lin, Wei-Che; Hsu, Che-Wei; Huang, Chi-Ren; Tsai, Nai-Wen; Chang, Chiung-Chih; Lu, Cheng-Hsien; Chang, Wen-Neng
• Is Part Of: Journal of clinical neuroscience. Volume 55(2018)
• Page Start: 57
• Page End: 61
• Publication Date: 2018-09
• Subjects: Acute/subacute cerebral infarct -- Basal meningeal enhancement -- Cryptococcal meningitis -- HIV-negative -- MRI -- Prognostic factor -- Seizure; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.06.044
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: To examine the prognostic factor of HIV-negative adult cryptococcal meningitis. The clinical and MRI features of 65 patients were analyzed. Seizure and acute/subacute cerebral infarct were significant prognostic factors. Acute/subacute cerebral infarct (ASCI) accounted for 21.5% of the patients. Basal meningeal enhancement is an important factor for the development of ASCI. Abstract: The prognostic significance of clinical characteristics and neuroimaging features, especially cranial magnetic resonance imaging (MRI)-based neuroimaging features, in patients with human immunodeficiency virus (HIV)-negative cryptococcal meningitis (CM) has rarely been examined in the literature. We analyzed the clinical characteristics and MRI findings of 65 HIV-negative patients (43 men, 22 women, age 19–86 years) collected during a study period of 15 years (January 2001–December 2015). Their underlying conditions included diabetes mellitus, liver cirrhosis, hematologic disorders, autoimmune disorders, malignancy, chronic obstructive pulmonary disease, adrenal insufficiency and organ transplantation, and their clinical presentations included headache, altered consciousness, fever, seizure, visual disturbance and hearing impairment. The main cranial MRI findings were basal meningeal enhancement (44.6%, 29/65), dilated Virchow-Robin space/pseudocyst (43.1%, 28/65), "dirty" cerebrospinal fluid sign (38.5%, 25/65), hydrocephalus (36.9%, 21/65), acute/subacute cerebral infarct (ASCI, 21.5%, 14/65), cryptococcoma (9.2%, 6/65), and hazy brain base (1.5%, 1/65). The therapeutic results of the 65 patients were evaluated using the Glasgow Outcome Scale (GOS). A comparison of the good outcome group (GOS score = 4–5, n = 37) and poor outcome group (GOS score = 1–3, n = 28) revealed that both the presence of seizures and ASCI were significantly associated with the prognosis. A comparison of the groups with ASCI (n = 14) and without ASCI (n = 51) revealed that the presence of basal meningeal enhancement was a significant factor for the development of ASCI, and that this correlation may be associated with intense basal meningeal inflammation in adjacent small vessels.