Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa; Cryptococcal Meningitis Group, Research Centre for Infection and Immunity, Division of Clinical Sciences, St. George's University of London, UK.
Department of Neurology, Grey's Hospital, Pietermaritzburg, South Africa.
J Infect. 2015 Jun;70(6):668-75. doi: 10.1016/j.jinf.2014.10.007. Epub 2014 Oct 22.
HIV-associated cryptococcal meningoencephalitis (CM) is a leading cause of adult meningitis in sub-Saharan Africa. Neuroradiological data is however limited to case reports and small case series from developed countries and/or immunocompetent patients.
Eighty seven patients aged ≥18 hospitalized with a first episode of CM had magnetic resonance (MRI) imaging during the first two weeks of admission. A subset of eleven patients had follow-up scans approximately one month from their initial MRI scan. All had prospectively-recorded detailed neurological and visual examinations.
An abnormal finding on neurological examination was detected in 33 (39%) patients. 38 (48%) patients experienced some visual loss. Neuroradiological lesions presumed to be cryptococcosis-related, as defined by the presence of dilated Virchow Robin spaces, pseudocysts or cryptococcomas, enhancing nodules, hydrocephalus, meningitis, focal perilesional oedema and infarcts, were detected in 55 (63%) patients. MRI findings suggestive of a second diagnosis were found in 18 (21%) patients. Visual loss was associated with the presence of cryptococcal-related lesions (p = 0.02). Blindness was associated with raised intracranial pressure (ICP) (p = 0.02). Of eleven patients with paired scans, brain swelling was identified on the initial scan in only one patient.
The majority of patients had MRI brain scan abnormalities presumed secondary to CM. Dilated Virchow Robin spaces were the commonest neuroradiological lesion. Visual loss was associated with the degree of cerebral involvement as reflected by the presence of MRI abnormalities. Blindness was associated with the presence of raised ICP. Initial generalised brain swelling does not appear to be common, but further studies with paired scans are needed.
HIV 相关隐球菌性脑膜脑炎（CM）是撒哈拉以南非洲成人脑膜炎的主要原因。然而，神经放射学数据仅限于来自发达国家和/或免疫功能正常患者的病例报告和小病例系列。
87 名年龄≥18 岁的首次发生 CM 的患者在入院的前两周内进行了磁共振成像（MRI）检查。11 名患者中有一部分在初始 MRI 扫描后大约一个月进行了随访扫描。所有患者均进行了前瞻性记录的详细神经学和视觉检查。
33 名（39%）患者的神经检查发现异常。38 名（48%）患者出现了一定程度的视力丧失。55 名（63%）患者的神经放射学病变被认为与隐球菌有关，这些病变通过存在扩大的 Virchow Robin 空间、假囊肿或隐球菌肿、增强结节、脑积水、脑膜炎、局灶性周边水肿和梗死来定义。18 名（21%）患者的 MRI 发现提示存在其他诊断。视力丧失与隐球菌相关病变的存在有关（p=0.02）。失明与颅内压升高（ICP）有关（p=0.02）。在 11 名具有配对扫描的患者中，只有 1 名患者在初始扫描中发现了脑肿胀。
大多数患者的 MRI 脑扫描异常被认为是 CM 的继发表现。扩大的 Virchow Robin 空间是最常见的神经放射学病变。视力丧失与脑受累程度有关，反映在 MRI 异常的存在上。失明与 ICP 升高有关。初始的弥漫性脑肿胀似乎并不常见，但需要进一步的配对扫描研究。
