Abstract Details

Title Lacunar Strokes in Cryptococcal Meningitis: Clinical and Radiographic Features in a U.S. Cohort

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-015

Objective We aim to describe clinical and radiographic features and predicting variables of stroke in a cohort of patients with cryptococcal meningitis.

Background Cryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequela and marked disability. We lack a clear understanding of the pathogenesis of the neurologic sequela and description of stroke features in this population. Ischemic stroke is a common complication of cryptococcal meningoencephalitis, affecting organ transplant recipients, patients with acquired immunodeficiency syndrome and occasionally immunocompetent patients.

Design/Methods A retrospective cohort study was performed in patients diagnosed with cryptococcal meningitis infection at the University of Colorado Hospital between 2000 and 2018 (n=42). Of those, 31 had neuroimaging studies available. A 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% vs. 8%, p=0.085) was higher in stroke in individuals with central nervous system cryptococcosis, although not statistically significant. 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 an RR of 5.7 (95% CI, 1.7-34, p=0.005). Cryptococcal meningitis leads to death in 17% 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 a highly prevalent complication which contributes to a high rate of neurologic disability among survivors. Prospective studies are needed to understand the contributing role of malignancy, anemia and hyponatremia in the onset of ischemic stroke and the mechanisms by which Cryptococcus results in an infectious vasculopathy and stroke.

Authors/Disclosures
Daniel Vela-Duarte, MD (Palm Beach Neuroscience Institute) PRESENTER	Dr. Vela-Duarte has nothing to disclose.
	No disclosure on file
Stefan Sillau	Stefan Sillau has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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