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Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis

S H Lan1, W N Chang, C H Lu

  • 1Departments of Neurology, Chang Gung Memorial Hospital Kaohsiung, Kaohsiung, Taiwan.

QJM : Monthly Journal of the Association of Physicians
|May 16, 2001
PubMed

Insights

Cerebral infarction complicates chronic meningitis, particularly tuberculous meningitis (TBM) and cryptococcal meningitis. High mortality and severe sequelae underscore the need for early diagnosis and treatment to improve outcomes for these neurological complications.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurocritical Care

Background:

  • Chronic meningitis, including tuberculous meningitis (TBM) and cryptococcal meningitis, can lead to cerebral infarction.
  • Cerebral infarction in this context presents with significant morbidity and mortality.
  • Understanding the specific patterns and outcomes of cerebral infarction in chronic meningitis is crucial for patient management.

Purpose of the Study:

  • To retrospectively identify and analyze cases of cerebral infarction secondary to chronic meningitis.
  • To determine the frequency of cerebral infarction in tuberculous meningitis and cryptococcal meningitis.
  • To evaluate the clinical features, outcomes, and associated neurological complications.

Main Methods:

  • Retrospective review of 28 patients with cerebral infarction secondary to chronic meningitis over 5 years.
  • Analysis of infarction distribution (single vs. multiple, anatomical location).
  • Assessment of therapeutic outcomes at 3 months using a modified Barthel Index.

Main Results:

  • Cerebral infarction occurred in 47% of TBM and 32% of cryptococcal meningitis cases.
  • 18 out of 28 patients had poor outcomes, including death (6) and severe neurological sequelae (12).
  • Common complications included hydrocephalus, cranial nerve palsy, and seizures; extracranial involvement was more frequent in TBM.

Conclusions:

  • Cerebral infarction is a serious complication of chronic meningitis with high mortality and morbidity.
  • Early diagnosis and prompt antimicrobial treatment are essential.
  • Ventricular decompression for hydrocephalus may prevent further cerebral ischemia.

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