Raised ICP in a child with cryptococcal meningitis: CT evidence of a distal CSF block

Date
1996
Authors
Schoeman J.F.
Honey E.M.
Loock D.B.
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Abstract
Raised intracranial pressure (ICP) often complicates the course of cryptococcal meningitis. The pathogenesis of the severely raised cerebrospinal fluid (CSF) pressure commonly associated with this condition is largely unexplained, because the majority of patients have normal cranial computed tomographic (CT) findings when diagnosed. We report a case of cryptococcal meningitis in a child who had severely raised CSF pressure on admission, and in whom repeated CT scanning showed progressive enlargement of the subarachnoid space and ventricular system during the course of treatment. The normalization of these spaces after ventriculoperitoneal (VP) shunting suggests a distal CSF block as the cause of the raised ICP in this patient. The CSF pressure was monitored and treatment with oral acetazolamide and furosemide resulted in a definite, but slow and incomplete lowering of ICP. Intrathecal therapy with hyaluronidase had no beneficial effect on either ICP or the degree of visual loss.
Description
Keywords
acetazolamide, amphotericin B, fluconazole, furosemide, hyaluronidase, article, brain ventricle peritoneum shunt, case report, computer assisted tomography, female, fungal meningitis, human, intracranial hypertension, intrathecal drug administration, intravenous drug administration, oral drug administration, priority journal, school child, Cerebrospinal Fluid, Child, Female, Humans, Hydrocephalus, Meningitis, Cryptococcal, Monitoring, Physiologic, Pseudotumor Cerebri, Subarachnoid Space, Tomography, X-Ray Computed, Ventriculoperitoneal Shunt
Citation
Child's Nervous System
12
9