Daniel Vela-Duarte1, Eric Nyberg2, Stefan Sillau3, Amy Pate4, Paula Castellanos5, Daniel B Chastain6, Carlos Franco-Paredes7, Andrés F Henao-Martínez8. 1. Department of Neurology, University of Colorado Denver. Electronic address: daniel.veladuarte@ucdenver.edu. 2. Department of Radiology, University of Colorado Denver. Electronic address: eric.nyberg@ucdenver.edu. 3. Department of Neurology, University of Colorado Denver. Electronic address: stefan.sillau@ucdenver.edu. 4. Department of Family Medicine, University of Colorado Denver. Electronic address: pate@udenver.edu. 5. Universidad de Manizales, Manizales, Colombia. Electronic address: paulitalcs@icloud.com. 6. Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia. Electronic address: daniel.chastain@uga.edu. 7. Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado; Hospital Infantil de México, Federico Gómez, México City, México. Electronic address: carlos.franco-paredes@ucdenver.edu. 8. Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado. Electronic address: andres.henaomartinez@ucdenver.edu.
Abstract
OBJECTIVE: Cryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequelae and marked disability. We lack a clear understanding of the pathogenesis of neurologic sequelae and description of stroke features in this population. We aim to describe clinical and radiographic features and predictors of stroke in a cohort of patients with cryptococcal meningitis. METHODS: We collected key information on patients diagnosed with cryptococcal meningitis at the University of Colorado Hospital between 2000 and 2018 (n = 42). Of those, 32 had neuroimaging studies available. Bivariate and risk ratio estimates regression models were performed to identify predictors of stroke. RESULTS: We found a 26% ischemic stroke complication rate in individuals with cryptococcal meningitis. Most strokes were acute (75%), lacunar (100%), multiple (88%), bilateral (63%), and involving the basal ganglia (75%). Presence of malignancy (38% versus 8%, P = .085) was higher in stroke in individuals with cryptococcal meningitis, although not statistically significant. Every unit decrease in hemoglobin and serum sodium were predictors for 1.35 and 1.14 times increase in the risk of ischemic stroke, respectively. The presence of hyponatremia carried a RR of 5.7 (95% confidence interval, 1.7-34, P = .005). Cryptococcal meningitis lead to death in 19% of patients and a considerable rate of neurologic sequela among survivors. CONCLUSIONS: Cryptococcal meningitis carries a high risk of lacunar stroke, particularly in the basal ganglia. Cryptococcal meningitis-associated stroke is common and frequently associated with neurologic disability among survivors. We need to understand the possible role of malignancy, anemia, and hyponatremia in the onset of ischemic stroke.
OBJECTIVE:Cryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequelae and marked disability. We lack a clear understanding of the pathogenesis of neurologic sequelae and description of stroke features in this population. We aim to describe clinical and radiographic features and predictors of stroke in a cohort of patients with cryptococcal meningitis. METHODS: We collected key information on patients diagnosed with cryptococcal meningitis at the University of Colorado Hospital between 2000 and 2018 (n = 42). Of those, 32 had neuroimaging studies available. Bivariate and risk ratio estimates regression models were performed to identify predictors of stroke. RESULTS: We found a 26% ischemic stroke complication rate in individuals with cryptococcal meningitis. Most strokes were acute (75%), lacunar (100%), multiple (88%), bilateral (63%), and involving the basal ganglia (75%). Presence of malignancy (38% versus 8%, P = .085) was higher in stroke in individuals with cryptococcal meningitis, although not statistically significant. Every unit decrease in hemoglobin and serum sodium were predictors for 1.35 and 1.14 times increase in the risk of ischemic stroke, respectively. The presence of hyponatremia carried a RR of 5.7 (95% confidence interval, 1.7-34, P = .005). Cryptococcal meningitis lead to death in 19% of patients and a considerable rate of neurologic sequela among survivors. CONCLUSIONS:Cryptococcal meningitis carries a high risk of lacunar stroke, particularly in the basal ganglia. Cryptococcal meningitis-associated stroke is common and frequently associated with neurologic disability among survivors. We need to understand the possible role of malignancy, anemia, and hyponatremia in the onset of ischemic stroke.
Authors: Gabriel Motoa; Amy Pate; Daniel Chastain; Sarah Mann; Gregory S Canfield; Carlos Franco-Paredes; Andrés F Henao-Martínez Journal: Ther Adv Infect Dis Date: 2020-07-08
Authors: Lasya R Penumarthi; Ricardo M La Hoz; Cameron R Wolfe; Brendan R Jackson; Aneesh K Mehta; Maricar Malinis; Lara Danziger-Isakov; Lynne Strasfeld; Diana F Florescu; Gabriel Vece; Sridhar V Basavaraju; Marian G Michaels Journal: Am J Transplant Date: 2021-02-02 Impact factor: 9.369
Authors: Gregory S Canfield; Andrés F Henao-Martínez; Carlos Franco-Paredes; Kristen Zhelnin; Michael L Wilson; Katherine C Shihadeh; David Wyles; Edward M Gardner Journal: Open Forum Infect Dis Date: 2019-10-23 Impact factor: 3.835