Diffusion tensor imaging study of white matter damage in chronic meningitis

Area of Science:

• Neurology
• Neuroimaging
• Infectious Diseases

Background:

• Tuberculous meningitis (TBM) and cryptococcal meningitis (CM) are leading causes of chronic meningitis.
• Chronic meningitis can lead to persistent neurological and cognitive impairments.

Purpose of the Study:

• To investigate the association between white matter (WM) micro-structure damage and chronic neuro-psychological sequelae in HIV-negative patients with TBM or CM.
• To identify potential neuroimaging biomarkers for disease evaluation.

Main Methods:

• Voxel-based diffusion tensor imaging (DTI) magnetic resonance imaging was used to assess WM integrity.
• Participants included HIV-negative TBM patients, HIV-negative CM patients, and healthy controls.
• Neuro-psychological testing, medical/neurologic examinations, and cerebrospinal fluid (CSF) analysis were performed.

Main Results:

• Patients with CM and TBM exhibited significant cognitive deficits compared to healthy controls.
• WM integrity was compromised in limbic regions (e.g., para-hippocampal gyrus, cingulate gyrus) and near the globus pallidus.
• Poorer DTI parameters correlated with worse cognitive performance and abnormal CSF profiles.

Conclusions:

• Micro-structure white matter damage, particularly in the limbic system and globus pallidus, is associated with neuro-psychological deficits in chronic meningitis.
• WM alterations may contribute to the psychopathology and pathophysiology of co-morbidities.
• Limbic and globus pallidus abnormalities show potential as biomarkers for disease assessment.