In this episode, Drs. Ronak Mistry and Jori May discuss the challenging...

Cryptococcal meningitis (CM) is a leading cause of fungal meningitis globally. Cerebral venous sinus thrombosis (CVST), though a recognized complication, has been rarely reported in both HIV-positive and HIV-negative individuals. This study investigates the incidence, clinical course, genetic factors, and neuroimaging features of CVST in a retrospective cohort of previously healthy, non-HIV CM patients.MethodsWe reviewed medical records of 89 immunocompetent CM patients admitted to the NIH Clinical Center between January 2005 and April 2024. CVST incidence, clinical course, neuroimaging, and laboratory data were analyzed. Genetic analysis was performed to detect any thrombophilia-associated variants. To explore thrombosis-related gene expression during neuroinflammation, cerebrospinal fluid (CSF) cells collected at the time of cryptococcal post-infectious inflammatory response syndrome (cPIIRS) diagnosis were subjected to single-cell RNA sequencing.ResultsCVST occurred in 5.6% (CI 1.9% - 12.6%) of CM patients, a rate comparable to bacterial CNS infections. No known pathogenic or likely pathogenic variants in known thrombophilia-associated genes were identified. However, 44 genes previously linked to thrombosis showed elevated expression—defined as ≥150 single-cell sequencing reads—in a cPIIRS patient.ConclusionCVST is a clinically significant and potentially treatable complication of CM, even in individuals without prior clotting abnormalities. MRI and MRV of the brain are valuable diagnostic tools. The absence of identifiable thrombophilia mutations suggests that neurologic infection itself contributes to thrombotic risk. Notably, CSF gene expression patterns may serve as biomarkers for CVST susceptibility. Future case-control studies may validate these findings and uncover genetic risk factors contributing to this severe complication.

The clinical utility of routine thrombophilia testing to guide management in pediatric venous thromboembolism (VTE) is debated. This study sought to e…

Lions and tigers and… thrombosis? Oh my! Join the Bloody Minded Crew on the yellow brick road to visit the emerald laboratory and see the wonderful wizard of clots - your friendly laboratory coagulati...

“HATE. LET ME TELL YOU HOW MUCH I'VE COME TO HATE YOU SINCE I BEGAN AS A HAEM REG. IF THE WORD HATE WAS ENGRAVED ON EACH NANO-ANGSTROM OF THE HUNDREDS OF MILLIONS OF CONSULT NOTES I HAVE WRITTEN IT WO...

Single or multiple trait thrombophilia are frequently determined in children with DVT. In these pediatric patients, detection of genetic thrombophilia did not predict early recurrence or progression of thrombus while on adequate anticoagula...

Single or multiple trait thrombophilia are frequently determined in children with DVT. In these pediatric patients, detection of genetic thrombophilia did not predict early recurrence or progression of thrombus while on adequate anticoagula...

Findings from the Women's Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use i...