Abstract
In Cryptococcus neoformans meningoencephalitis, brain MRI findings might reflect the phathomechanism of disease progression that is fungal accumulation in the peri-venular space and consequent invasion into the parenchyma. This study analyzed serial brain MRI findings of 76 patients with cryptococcus meningoencephalitis in association with the disease progression and outcomes. MRI parameters included the enlarged periventricular space (ePVS) score (range 0–8), periventricular lesion extension, cryptococcoma, and hydrocephalus. Clinical outcomes at 2-week, 10-week, and 6-month were evaluated using modified Rankin scale (mRS). At 6 months, 15 (19.7%) patients died and 34 (44.1%) had poor neurological outcomes (mRS scores > 2). At baseline, an ePVS score of ≥ 5 (Odds-ratio [OR]: 94.173, 95% confidence-interval [95%CI]: 7.507–1181.295, P < .001), periventricular lesion extension (OR: 51.965, 95%CI: 2.592–1041.673, P = .010), and presence of encephalitis feature (OR: 44.487, 95%CI: 1.689–1172.082, P = .023) were associated with 6-month poor outcomes. Presence of two or more risk factors among encephalitis feature, ePVS score ≥ 5, and periventricular lesion extension at baseline, was associated with 6-month poor outcomes (area under the curve [AUC]: 0.978, P < .001) and mortality (AUC: 0.836, P < .001). Disease progression was associated with interval development of cryptococcoma and hydrocephalus. Brain MRI findings might be useful in predicting outcomes and monitoring the progression of cryptococcus meningoencephalitis.
Highlights
Cryptococcus neoformans meningoencephalitis is a serious central nervous system (CNS) complication in immunocompromised patients and is associated with a high mortality r ate[1,2,3,4]
Given that Enlarged perivascular space (ePVS) might reflect the perivascular cerebrospinal fluid (CSF) flow stagnation caused by Cryptococcus accumulation, its degree might predict the risk of disease progression and poor outcomes
Materials and methods Study subjects. This retrospective cohort study initially included all consecutive individuals admitted to the neurology department of the Seoul National University Hospital between January 2000 and December 2019 who were diagnosed with Cryptococcus meningoencephalitis
Summary
Cryptococcus neoformans meningoencephalitis is a serious central nervous system (CNS) complication in immunocompromised patients and is associated with a high mortality r ate[1,2,3,4]. A marker that reflects the disease pathomechanism and estimates the risk of disease progression and poor neurological outcome is still lacking[6,7]. Considering that the peri-venular space lacks pial m embrane[11], it can be postulated that the degree of peri-venular flow stagnation caused by the accumulated Cryptococcus might determine the risk of Cryptococcus invasion into the brain parenchyma, manifesting as the progression of d isease[4,10]. Given that ePVS might reflect the perivascular CSF flow stagnation caused by Cryptococcus accumulation, its degree might predict the risk of disease progression and poor outcomes. We hypothesized that brain MRI findings might reflect the pathomechanism underlying disease progression and predict the outcomes of Cryptococcus meningoencephalitis, and analyzed the brain MRI findings, their serial changes, and its association with the disease progression and outcomes
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