title: Long-term neuropsychological sequelae in HIV-seronegative cryptococcal meningoencephalitis patients with and without ventriculoperitoneal shunts: a cine MRI study.
abstract: BACKGROUND
  Hydrocephalus in cryptococcal meningoencephalitis is most commonly managed with a ventriculoperitoneal shunt. This study applied cine magnetic resonance imaging (MRI) to evaluate initial disease severity on long-term cerebrospinal fluid (CSF) flow dynamics and associated neuropsychological sequelae in cryptococcal meningoencephalitis patients with and without ventriculoperitoneal shunts.
  
  
  METHODS
  Eighteen human immunodeficiency virus-seronegative cryptococcal meningoencephalitis patients (10 with shunts versus 8 without shunts) were compared with 32 age- and sex-matched healthy volunteers. All subjects underwent complete neurologic examination and neuropsychological testing. Cine MRI was conducted to evaluate CSF flow parameters. Initial CSF laboratory analysis and imaging findings were correlated with present CSF flow parameters and neuropsychological scores.
  
  
  RESULTS
  Patients without shunts had higher average flow than controls, suggesting chronic hydrocephalus. Initial Evans ratios and CSF glucose levels were associated with CSF peak velocity and flow. Worsening CSF flow parameters correlated with decreased neuropsychological performance.
  
  
  CONCLUSIONS
  CSF flow parameter differences between the cryptococcal meningoencephalitis patients both with and without ventriculoperitoneal shunts could be detected by cine MRI and correlated with acute stage disease severity and chronic stage neuropsychological results. Cine MRI is useful for assessing the chronic hydrocephalus that may lead to neuropsychological deficits in cryptococcal meningoencephalitis patients.
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Meng-Hsiang
authors.identifier: 0000-0003-0201-9015
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan ; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan ; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei 11221, Taiwan.
authors.forename: Hsiu-Ling
authors.initials: HL
authors.lastname: Chen
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.affiliation: Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Shau-Hsuan
authors.identifier: 0000-0002-7140-9132
authors.initials: SH
authors.lastname: Li
authors.affiliation: Department of Radiology, Yuan's General Hospital, Kaohsiung 802, Taiwan.
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Hsu
authors.affiliation: Department of Radiology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83305, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid* / Q000150:complications / Q000503:physiopathology* / Q000821:virology; D008875:Middle Aged; D013995:Time; D017287:Ventriculoperitoneal Shunt / Q000379:methods