Spectrum of neuroimaging findings in cryptococcal meningitis in immunocompetent patients in China — A series of 18 cases

• Published in: Journal of the neurological sciences 2016-09, Vol.368, p.132-137
• Main Authors: Tan, Zhe-Ren, Long, Xiao-Yan, Li, Guo-Liang, Zhou, Jin-Xia, Long, Lan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain - diagnostic imaging; China; Cryptococcal meningitis; Cryptococcoma; Dilated Virchow-Robin spaces; Female; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal - cerebrospinal fluid; Meningitis, Cryptococcal - diagnostic imaging; Middle Aged; MRI; Neurology; Retrospective Studies; Young Adult
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2016.06.069

Abstract Purpose Cryptococcosis is a devastating opportunistic disease commonly encountered in organ transplant recipients and patients with acquired immunodeficiency syndrome (AIDS). Few studies have profiled the disease in immunocompetent patients. We sought to characterize the neuroimaging findings of cryptococcal meningitis among immunocompetent patients in China. Materials and methods Retrospective review of all patients diagnosed with cryptococcal meningitis at our institute, on the basis of CSF culture or India Ink test, between November 2011 and February 2016, was performed. Only apparently immunocompetent patients, for whom at least one brain MRI examination was performed, were included in the analysis. The MRI results were available for all these patients before CSF diagnosis. Data related to variables such as patient demographics, clinical features, neuroimaging characteristics and CSF findings were analyzed. Results Eighteen apparently immunocompetent patients, for whom brain MRI radiographs were available, were included in the analysis. Abnormal MRI findings were observed in 16 patients. These included multiple intraparenchymal lesions with or without enhancement, prominent basal ganglia involvement, miliary distribution of parenchymal nodules, multiple dilated Virchow-Robin spaces and leptomeningeal enhancement. Six patients had ventriculomegaly. Conclusion In our study, intraparenchymal findings were more common than leptomeningeal enhancement and perivascular lesions. Cryptococcal meningitis should be considered in the differential diagnosis of immunocompetent patients with brain MRI findings of prominent parenchymal involvement such as bilateral patchy lesions in basal ganglia or miliary distribution of parenchymal nodules.