Cerebrovascular injury in cryptococcal meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Cryptococcal meningitis is a significant cause of chronic central nervous system infection globally.
• Small vessel vasculitis in cryptococcal meningitis can lead to infarcts, particularly in the basal ganglia, internal capsule, and thalamus.
• Limited literature exists on the patterns and outcomes of cerebrovascular injury in cryptococcal meningitis.

Purpose of the Study:

• To investigate the clinical and imaging characteristics of central nervous system (CNS) infarcts in patients with cryptococcal meningitis.
• To determine the vascular territories affected by these infarcts.
• To compare mortality and morbidity rates between cryptococcal meningitis patients with and without CNS infarcts.

Main Methods:

• Retrospective analysis of 151 patients with proven cryptococcal meningitis over 11 years.
• Inclusion of 66 patients with adequate brain imaging for infarct assessment by two radiologists.
• Comparison of clinical data and outcomes between patients with and without CNS infarcts.

Main Results:

• 13% of patients (20/151) showed evidence of CNS infarcts.
• Infarcts were predominantly lacunar, acute (60%), and often multiple (50%).
• Basal ganglia were the most common site; infarcts were unilateral in 70% of cases.
• Patients with infarcts had longer illness duration, lower GCS, and more meningeal inflammation, cryptococcomas, and basal exudates.
• Neurovascular involvement significantly increased the risk of morbidity (OR 9.1) and mortality (OR 2.6).

Conclusions:

• Neurovascular involvement, manifesting as multiple lacunar infarcts, is a rare but significant complication of cryptococcal meningitis.
• These infarcts are associated with substantially higher rates of mortality and morbidity.
• Vascular injury is a critical predictor of outcomes in cryptococcal meningitis, warranting further research into underlying mechanisms.