Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients

King, Kelly A.; Ansari, Ghedak; Panackal, Anil A.; Zalewski, Chris; Anjum, Seher; Bennett, John E.; Beri, Andrea; Kim, Hung Jeff; Hammoud, Dima A.; Brewer, Carmen C.; Williamson, Peter R.

doi:10.1097/mao.0000000000002242

Cited by 15 publications

(3 citation statements)

References 37 publications

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“…Although increased diameter of the optic sheath, measured 3 mm behind the globe, has been reported to correlate with increased intracranial pressure, the specific imaging requirements (dedicated imaging of the orbit with and without fat suppression) were not met in our study [ 37 ]. To detect MRI abnormalities associated with cranial nerve palsies, additional imaging techniques may be needed, as we have reported with decreased auditory function in cryptococcal meningitis [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

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Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Anjum

Bennett

Dean

et al. 2023

JoF

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Background: A clearer understanding is needed about the use of brain MRI in non-HIV patients with cryptococcal meningitis. Methods: Cerebral CT and MRI were studied in 62 patients in a multicenter study of cryptococcal meningitis in non-HIV patients. CT was performed in 51 and MRI in 44. MRI results are reported for the images read at NIH for 29 of the 44 patients. CT reports obtained from the original REDCap database were added to calculate the incidence of normal findings. Results: CTs were read as normal in 24 of 51 (47%), MRIs were normal in 10% (three of 29). The most characteristic lesions of cryptococcal meningitis on MRI were small basal ganglia lesions representing dilated perivascular spaces in 24% and basal ganglia lesions with restricted diffusion (infarcts) in 38%. In the 18 patients who received contrast, contrast-enhancing lesions, likely representing masses of cryptococci and inflammatory cells, were found in the basal ganglia in 22% and elsewhere in the brain in 22%. Meningeal enhancement was seen in 56%, ependymal enhancement in 24%, and choroid plexus enhancement in 11%. Hydrocephalus was found in five (18%), though increased intacranial pressure was not detected. Suboptimal imaging (n = 6), lack of contrast administration (n = 11) and lack of follow-up, however, markedly limited the accurate assessment of abnormalities in multiple cases. Conclusion: MRI characteristics of non-HIV cryptococcal meningitis include hydrocephalus, meningeal and ependymal enhancement and basal ganglia lesions. Optimal imaging is, however, necessary to maximize the diagnostic and prognostic usefulness of MRI.

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Section: Discussionmentioning

confidence: 99%

“…To detect MRI abnormalities associated with cranial nerve palsies, additional imaging techniques may be needed, as we have reported with decreased auditory function in cryptococcal meningitis [38].…”

Section: Clinical Correlatesmentioning

confidence: 99%

Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Anjum

Bennett

Dean

et al. 2023

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“…Diplopia, especially that caused by CN-VI palsy is also a common presentation ( 23 ). Auditory symptoms that can either be unilateral or bilateral include loss of hearing or a “whooshing” sound and can be associated with inflammation of CN-VII or the internal auditory canal ( 24 ). Gait abnormalities are also common and may be the result of an accompanying spinal arachnoiditis or hydrocephalus ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

et al. 2022

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Cryptococcal meningoencephalitis (CM) continues to cause major morbidity and mortality in a range of patients such as those immunosuppressed from HIV and with biologic immunosuppressants, including treatments of autoimmunity, malignancies, and conditioning regimens for transplantation. It is currently the most common cause of non-viral meningitis in the United States. Infections in previously healthy patients also develop with autoantibodies to granulocyte-macrophage colony stimulating factor or with monogenetic defects. In all populations, mortality and significant long-term morbidity occur in 30–50% despite therapy, and immune reconstitution and post-infectious inflammatory response syndromes complicate management. To help with these difficult cases, we present here a practical tutorial of the care of a range of patients with CM in the absence of HIV/AIDS.

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Meningoencephalitis in Children and Hearing Loss

Maraş Genç,

Kara,

Arısoy

et al. 2023

Comprehensive ENT

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Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients

Cited by 15 publications

References 37 publications

Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

Meningoencephalitis in Children and Hearing Loss

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