Lumbar drainage for control of raised cerebrospinal fluid pressure in cryptococcal meningitis: case report and review

J Infect. 2005 Nov;51(4):e221-4. doi: 10.1016/j.jinf.2005.02.010.

Abstract

Raised intracranial pressure in the absence of ventricular dilatation is common in cryptococcal meningitis and associated with increased mortality. We report the case of a patient with HIV-associated cryptococcal meningitis, who developed increasing CSF pressure and visual impairment on therapy despite serial lumbar punctures. Insertion of a temporary lumbar drain controlled the opening pressure and resulted in full visual recovery. The advantages and necessary precautions with this approach are reviewed, and alternative protocols for the use of lumbar drains discussed.

Publication types

  • Case Reports
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / microbiology
  • AIDS-Related Opportunistic Infections / physiopathology
  • AIDS-Related Opportunistic Infections / therapy*
  • Adult
  • Amphotericin B / administration & dosage
  • Antifungal Agents / administration & dosage
  • Cerebrospinal Fluid Pressure*
  • Cryptococcus neoformans / isolation & purification
  • Deoxycholic Acid / administration & dosage
  • Drainage / instrumentation
  • Drainage / methods
  • Drug Combinations
  • Female
  • Fluconazole / administration & dosage
  • Flucytosine / administration & dosage
  • HIV-1* / immunology
  • Humans
  • Meningitis, Cryptococcal / microbiology
  • Meningitis, Cryptococcal / physiopathology
  • Meningitis, Cryptococcal / therapy*
  • Spinal Puncture / methods*
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Drug Combinations
  • Deoxycholic Acid
  • Amphotericin B
  • amphotericin B, deoxycholate drug combination
  • Fluconazole
  • Flucytosine