Sarkis Rani A, Mays Maryann, Isada Carlos, Ahmed Manzoor
Departments of *Neurology ‡Neuroradiology, Neurological Institute †Infectious Diseases, Cleveland Clinic, Cleveland, OH.
Neurologist. 2015 Jan;19(2):40-5. doi: 10.1097/NRL.0000000000000000.
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.
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.
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.
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.
隐球菌性脑膜炎是一种机会性感染，可侵袭免疫功能正常和免疫功能低下的个体。HIV人群中的影像学表现已有充分描述；然而，很少有研究关注非HIV人群。本研究的目的是描述非HIV人群的临床和磁共振成像（MRI）表现。
我们对1997年至2009年间脑脊液隐球菌抗原阳性且非HIV阳性的患者进行了回顾性病历审查。仅纳入了有脑部MRI检查的患者。收集的数据包括脑脊液检查结果、血液和脑脊液隐球菌滴度，以及有关免疫抑制药物使用的信息。
19名患者符合研究标准，74%的患者有异常影像学表现。10名患者因癌症、器官移植或疑似血管炎而使用免疫抑制剂。4名患者无已知危险因素，2名患者有特发性低CD4细胞计数。隐球菌性脑膜炎的MRI表现包括软脑膜强化，伴或不伴有微结节样表现、累及颞叶或基底节的微囊性突出、脑室扩大和脑脓肿。2名患者在Luschka孔处有后颅窝囊肿。5名患者MRI正常。
在我们的系列研究中，非HIV人群隐球菌性脑膜炎的MRI表现比以前认识到的更为常见。在该患者群体中，软脑膜强化和脑室内囊性病变比脑实质内表现更为常见。
