Risk Factors Of Acute/subacute Cerebral Infarction In HIV-negative Patients With Cryptococcal Meningitis: A Matched Case-control Study

Objective: To explore the risk factors of acute/subacute cerebral infarction(ASCI) in HIV-negative patients with cryptococcal meningitis(CM).Methods: This multi-center case-control study included 12 HIV-negative CM patients with ASCI and 36 age- and sex- matched controls(1:3) who were HIV-negative CM patients without ASCI. Clinical manifestations and neuroimaging findings were collected. Risk factors of ASCI in HIV-negative CM patients were confirmed by conditional logistic regression analysis.Results: In the 12 HIV-negative CM patients with ASCI, single infarctions were found in 7 patients and multiple infarctions in 5. All cases were lacunae infarctions. The locations of ASCI were mainly in basal ganglia 4, thalamus 3, callosum 3, cerebral cortex 3, cerebellum 2 and brainstem 1. Vomiting(p=0.046), cranial nerve injury(p<0.001) and paralysis(p<0.001) were the major clinical manifestations. Hydrocephalus(p=0.011, OR=28.56, 95% CI, 2.17-375.32) and smoking(p=0.036, OR=12.58, 95% CI, 1.19-133.23) were found to be independently associated with the occurrence of ASCI.Conclusions: Single lacunar infarction was the most common type in HIV-negative CM patients with ASCI. Vomiting(p=0.046), cranial nerve injury(p<0.001) and paralysis(p<0.001) were the significant clinical manifestations. Hydrocephalus and smoking may increase the risk of ASCI in HIV-negative CM patients. In the clinical course, high possibility of cerebral infarction should be suspected in CM patients with hydrocephalus or smoking history.