Neuroimaging as a Guide to Predict Outcomes for Patients with Coccidioidal Meningitis

Arsura, Edward L.; Johnson, Royce H.; Penrose, James; Stewart, Kenneth J.; Kilgore, William B.; Reddy, Chakradhar; Bobba, Ravi K.

doi:10.1086/427215

Cited by 50 publications

(25 citation statements)

References 11 publications

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“…Hydrocephalus is a major contributor to CM-related morbidity and mortality. In a series of patients with CM, hydrocephalus complicated about 20% to 50% of cases [16][17][18], and was associated with a 12-fold increased risk of mortality [17].…”

Section: Hydrocephalusmentioning

confidence: 99%

“…Neuroimaging abnormalities are commonly identifi ed in up to 75% of patients with CM [17,25]. MRI of the brain is more sensitive in identifying abnormalities than CT scanning, and often identifi es abnormalities at the initial evaluation for CM [17,25].…”

Section: Neuroimagingmentioning

confidence: 99%

Section: Neuroimagingmentioning

confidence: 99%

“…MRI of the brain is more sensitive in identifying abnormalities than CT scanning, and often identifi es abnormalities at the initial evaluation for CM [17,25]. Patients with CM with abnormal neuroimaging had a mortality rate of 32%, compared with 8% of patients with no abnormal neuroimaging fi ndings [17]. Meningitis can be identifi ed by enhancement of the basal cisterns, Sylvian fi ssures, craniocervical junction, or pericallosal regions; diffuse meningeal enhancement is more common than focal enhancement [25].…”

Section: Neuroimagingmentioning

confidence: 99%

“…Meningitis can be identifi ed by enhancement of the basal cisterns, Sylvian fi ssures, craniocervical junction, or pericallosal regions; diffuse meningeal enhancement is more common than focal enhancement [25]. Hydrocephalus is evidenced by dilatation of the lateral ventricles, rounding and enlargement of the frontal horns, or an increase in size and rounding of the temporal horns without associated generalized atrophy of cerebral tissue [17]. Acute deep cerebral infarcts or edema in association with hydrocephalus or meningitis are seen in 30% to 40% of patients [17,25,26].…”

Section: Neuroimagingmentioning

confidence: 99%

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Coccidioidal meningitis: Update on epidemiology, clinical features, diagnosis, and management

Blair

2009

Curr Infect Dis Rep

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Coccidioidomycosis is a fungal infection endemic to geographically restricted areas of the southwestern United States, and its incidence is increasing within endemic areas. Coccidioidal meningitis, an infrequent but very severe form of coccidioidomycosis, is associated with significant mortality and morbidity. The diagnosis depends on the demonstration of coccidioidal antibody or positive culture, histopathology, or cytology in the presence of typical abnormalities of the cerebrospinal fluid. Central nervous system complications of this infection may include hydrocephalus, vasculitis, infarctions, or parenchymal abscesses. Many patients with coccidioidal meningitis can achieve remission of infection following treatment with triazole antifungal agents. However, first-line therapy with high-dose oral fluconazole is associated with a high incidence of relapse after drug discontinuation. This article summarizes the pathogenesis, epidemiology, clinical manifestations, diagnostic studies, and treatment of coccidioidal meningitis, and highlights new information regarding this devastating infection.

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Section: Hydrocephalusmentioning

confidence: 99%

Section: Neuroimagingmentioning

confidence: 99%