Diffusion tensor imaging study of white matter damage in chronic meningitis.

Wei-Che Lin,Hung-Chen Wang,Shau-Hsuan Li,Cheng-Hsien Lu,Yu-Jih Su,Pei-Chin Chen,Wen-Neng Chang,Kun-Hsien Chou,Nai-Wen Tsai,Ching-Po Lin,Hsiu-Ling Chen,Joseph Najbauer

doi:10.1371/journal.pone.0098210

Abstract

Tuberculous meningitis (TBM) and cryptococcal meningitis (CM) are two of the most common types of chronic meningitis. This study aimed to assess whether chronic neuro-psychological sequelae are associated with micro-structure white matter (WM) damage in HIV-negative chronic meningitis. Nineteen HIV-negative TBM patients, 13 HIV-negative CM patients, and 32 sex- and age-matched healthy volunteers were evaluated and compared. The clinical relevance of WM integrity was studied using voxel-based diffusion tensor imaging (DTI) magnetic resonance imaging. All of the participants underwent complete medical and neurologic examinations, and neuro-psychological testing. Differences in DTI indices correlated with the presence of neuro-psychological rating scores and cerebrospinal fluid (CSF) analysis during the initial hospitalization. Patients with CM had more severe cognitive deficits than healthy subjects, especially in TBM. There were changes in WM integrity in several limbic regions, including the para-hippocampal gyrus and cingulate gyrus, and in the WM close to the globus pallidus. A decline in WM integrity close to the globus pallidus and anterior cingulate gyrus was associated with worse CSF analysis profiles. Poorer DTI parameters directly correlated with worse cognitive performance on follow-up. These correlations suggest that WM alterations may be involved in the psychopathology and pathophysiology of co-morbidities. Abnormalities in the limbic system and globus pallidus, with their close relationship to the CSF space, may be specific biomarkers for disease evaluation.

Highlights

Tuberculous meningitis (TBM) and cryptococcal meningitis (CM) are two of the most common types of chronic meningitis
Statistical analysis of the clinical manifestations and neuro-imaging findings between patient groups were significant for cerebrospinal fluid (CSF) glucose level (p = 0.018), CSF/serum glucose ratio (p = 0.030), and VP shunt use
There was no significant difference in magnetic resonance imaging (MRI) findings between the acute phase and follow-up

Summary

Introduction

Tuberculous meningitis (TBM) and cryptococcal meningitis (CM) are two of the most common types of chronic meningitis They have similar clinical presentations and cerebrospinal fluid (CSF) features and despite the advent of new antimicrobial therapies, their morbidity and mortality remain high. Diffusion tensor imaging (DTI) is a non-invasive technique that can explore and provide evidence of micro-structural features of WM that can be closely correlated with differences in cognitive functions [9,10,11,12]. It can quantify peri-ventricular white matter (WM) changes in neonatal meningitis and suggest that patients with abnormal outcome have decreased anisotropy values [13]. Manual analysis of regions of interest in a spectrum of meningitisrelated abnormalities based on previous reports may overlook and underestimate injury to the global brain parenchyma from meningitis

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