Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis

Abstract

Twenty-eight patients with cerebral infarction secondary to chronic meningitis were retrospectively identified at our institution over a period of 5 years. They accounted for 47% (17/36) of tuberculous meningitis (TBM) and 32% (11/34) of cryptococcal meningitis cases. Single infarctions were found in 15 patients and multiple infarctions in 13. The distribution of single infarctions was: basal ganglia 7; internal capsule 3; thalamus 1; cerebellum 1; and cortical infarct 3. Therapeutic outcomes at 3 months were determined using a modified Barthel INDEX: At follow-up of 3 months or more, 10 had good outcomes while the other 18 had poor outcomes. The 18 with poor outcomes included six who died, and 12 who had severe neurological sequelae. TBM and cryptococcal meningitis shared similar clinical features, both being frequently associated with other neurological complications, including hydrocephalus, cranial nerve palsy, and seizures in our patients. However, extracranial involvement, such as spinal and pulmonary involvement, was more commonly found in TBM patients. Cerebral infarction can occur in both the acute stage and later stages of treatment. Mortality and morbidity are high, and early diagnosis and appropriate antimicrobial treatment are essential. If hydrocephalus is demonstrated, early ventricular decompression is needed to prevent further cerebral ischaemia.

Assessing the Chronic Neuropsychologic Sequelae of Human Immunodeficiency Virus–Negative Cryptococcal Meningitis by Using Diffusion Tensor Imaging

“…[1][2][3][4] Although antifungal therapy has been introduced, the high rate of neurologic sequelae among survivors indicates that therapy for CM is far from being satisfactory. [5][6][7] New nonconventional MR imaging techniques such as DWI have been proposed as tools to improve diagnostic accuracy and achieve a better understanding of the pathophysiology and psychology of the diseased brain. 8,9 DTI, a DWI technique, provides a quantitative noninvasive method for delineating anatomic integrity, particularly for the WM pathways, by measuring the extent and direction of diffusion.…”

Clinical Reasoning: A 73-year-old man with sarcoidosis and multifocal ischemic strokes

“…Exudates in the setting of chronic meningitis are typically found in the basal cisterns, which may explain why the majority of infarcts in patients with CM are observed in the basal ganglia, internal capsule, or thalamus. 7 Although hydrocephalus is a common complication of CM and may contribute to cerebral ischemia by stretching vessels or increasing intracranial pressure, 7 this did not seem to be a major factor in the pathology of our patient.…”

A Rare Case of Cryptococcus Meningoencephalitis Presenting with Acute Brainstem Infarction in an Immunocompetent Host

“…Several pathophysiologic mechanisms have been proposed in the development of cerebral infarctions in meningitis, including: (i) vasculitis of vessels that transverse the exudates at the base of the brain, resulting in inflammation-induced spasms, constriction, and thrombosis; (ii) meningeal inflammatory exudate involving the adventitia that spreads progressively until it affects the entire vessel wall, leading to necrotizing panarteritis with secondary thrombosis and occlusion; and (iii) dilated ventricles stretching an already-compromised vessel [9].…”