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Published on: November 20, 2015
MRI findings in cryptococcal meningitis of the non-HIV population
Rani A Sarkis1, Maryann Mays, Carlos Isada
1Departments of *Neurology ‡Neuroradiology, Neurological Institute †Infectious Diseases, Cleveland Clinic, Cleveland, OH.
Objectives:
Cryptococcal meningitis is an opportunistic infection which can afflict immunocompetent and immunocompromised individuals. Imaging findings in the HIV population are well described; however, few studies have focused on the non-HIV population.The purpose of this study is to characterize clinical and magnetic resonance imaging (MRI) findings in the non-HIV population.
Methods:
We performed a retrospective chart review of patients with positive CSF cryptococcal antigen (between 1997 and 2009) who were not HIV positive. Only patients with MRIs of the brain were included. Data collected included CSF findings, blood and CSF cryptococcal titers, and information regarding the use of immunosuppressant drugs.
Results:
Nineteen patients fulfilled study criteria, and 74% of the patients had abnormal imaging.Ten patients were on immunosuppressants due to cancer, organ transplantation, or presumed vasculitis. Four patients had no known risk factors and 2 patients had idiopathic low CD4 counts.MRI findings in cryptococcal meningitis included leptomeningeal enhancement with or without a micronodular pattern, microcystic prominence involving the temporal lobes or basal ganglia, ventriculomegaly, and a brain abscess. Two patients had posterior fossa cysts at the foramen of Luschka. Five patients had a normal MRI.
Conclusions:
MRI findings in cryptococcal meningitis of the non-HIV population were more common in our series than previously recognized. In this patient population, leptomeningeal enhancement and intraventricular cystic lesions were more common than intraparenchymal findings.
Insights
Magnetic resonance imaging (MRI) reveals common abnormalities in non-HIV cryptococcal meningitis. Leptomeningeal enhancement and intraventricular cysts are frequent findings in this opportunistic infection.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cryptococcal meningitis is an opportunistic infection affecting both immunocompetent and immunocompromised individuals.
- While imaging findings in HIV-positive patients are documented, research on non-HIV populations is limited.
Purpose of the Study:
- To characterize the clinical and magnetic resonance imaging (MRI) findings of cryptococcal meningitis in patients without HIV.
Main Methods:
- Retrospective review of patients with positive cerebrospinal fluid (CSF) cryptococcal antigen from 1997-2009.
- Inclusion criteria required patients to be non-HIV positive and have brain MRI scans.
- Data included CSF analysis, cryptococcal titers, and immunosuppressant drug use.
Main Results:
- Seventy-four percent of the 19 included patients showed abnormal MRI findings.
- Common MRI findings included leptomeningeal enhancement, microcystic prominence, ventriculomegaly, and brain abscess.
- Intraventricular cystic lesions were observed in the posterior fossa.
Conclusions:
- MRI findings in non-HIV cryptococcal meningitis are more prevalent than previously thought.
- Leptomeningeal enhancement and intraventricular cysts are more common than intraparenchymal findings in this population.
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