Ventriculoperitoneal shunt for intracranial hypertension in cryptococcal meningitis without hydrocephalus

Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Journal of Clinical Neuroscience (Impact Factor: 1.38). 06/2012; 19(8):1175-6. DOI: 10.1016/j.jocn.2012.01.008
Source: PubMed


The use of a ventriculoperitoneal (VP) shunt to treat uncontrollable intracranial hypertension in patients with cryptococcal meningitis without hydrocephalus is somewhat unusual and still largely unreported. However, uncontrollable intracranial hypertension without hydrocephalus in these patients is a potentially life-threatening condition. Early diagnosis and shunt placement are essential to improve survival and neurological function. We report uncontrollable intracranial hypertension without hydrocephalus in a 23-year-old woman, which was successfully managed by VP shunt placement.

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    ABSTRACT: Visual loss in cryptococcal meningitis has been postulated to be due to papilloedema and/or optic neuritis. A 28-year-old human immunodeficiency virus (HIV)-positive female presented with visual loss, swollen optic discs, and elevated intracranial pressure due to cryptococcal meningitis. Computerised tomographic cisternography and T2-weighted magnetic resonance imaging showed occlusion of the peri-optic subarachnoid space and its reopening after serial lumbar punctures. Presumably lowering of the intracranial pressure resulted in equalisation of pressure across the pressure gradient created by the fungal block. This case supports a third mechanism of visual loss in cryptococcal meningitis, namely, an optic nerve compartment syndrome, that seems more plausible as the principal mechanism.
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    Clinical Neurology and Neurosurgery 09/2014; 124. DOI:10.1016/j.clineuro.2014.07.001 · 1.13 Impact Factor
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