Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

Background: Descriptions of the patterns of acute/subacute cerebral infarction (ASCI) in HIV-negative patients with cryptococcal meningitis (CM) are scarce, and the predictors of ischemic stroke and outcomes following ASCI with CM remain unclear. Aim To study the clinical characteristics and evaluate the predictors of ASCI in HIV-negative patients with CM and assess the impact of ischemic stroke on the outcomes of the patients. Methods We retrospectively analyzed the data of 61 HIV-negative patients with CM treated between January, 2016 and February, 2022, and among them, 53 patients with complete neuroimaging and cerebrospinal fluid (CSF) data were enrolled in this study. The cohort was stratified by the occurrence of ASCI diagnosed based on MRI evidences for comparison of the clinical characteristics, laboratory data, imaging findings and outcomes of the patients. Logistic regression analysis was used to identify the risk factors of ASCI in the HIV-negative patients with CM. Results ASCI occurred in 26.4% (14/53) of the HIV-negative patients with CM. The incidences of fever, headache, neck stiffness, duration of symptoms, CSF parameter, meningeal enhancement in brain MRI and the treatment regimens were similar between the patients with and those without ASCI. Most of the infarcts (92.9%) were of the lacunar type, involving both the anterior and posterior territories. Basal ganglia-corona radiata and the brainstem-cerebellum were the most frequently involved sites. Logistic regression analysis suggested that consciousness disorder ( P  = 0.002), MRI evidence of hydrocephalus ( P  = 0.042) and posterior fossa exudates ( P  = 0.028) were all independent predictors of ASCI in these HIV-negative patients with CM. Compared with patients without ASCI, the HIV-negative patients with CM and ASCI had unfavorable outcomes ( P  = 0.001). Conclusion ASCI is relatively rare in HIV-negative patients with CM, presented commonly as multiple lacunar infarctions involving all the cerebrovascular territories. The presence of consciousness disorder, hydrocephalus and posterior fossa exudates may increase the risk of ASCI in patients with CM. ASCI is associated with a poor outcome of the HIV-negative patients with CM.