Visual loss in HIV-associated cryptococcal meningitis: A case series and review of the mechanisms involved

Area of Science:

• Neuro-ophthalmology
• Infectious Diseases
• Medical Imaging

Background:

• Cryptococcal meningitis is a significant cause of preventable visual loss.
• Traditional understanding implicated optic neuritis and papilledema.
• Lack of clear guidelines for managing visual loss in this condition.

Purpose of the Study:

• To present clinical and electrophysiological findings of visual loss in HIV-co-infected patients with cryptococcal meningitis.
• To review the mechanisms of visual loss, including newly identified ones.
• To emphasize the role of intracranial pressure in cryptococcus-induced visual impairment.

Main Methods:

• Case series of 90 HIV co-infected patients.
• Clinical and electrophysiological assessments.
• Review of mechanisms including high-resolution MRI findings.

Main Results:

• Identified optic nerve sheath compartment syndrome (ONSCS) as an additional mechanism.
• ONSCS is linked to elevated intracranial pressure and fungal presence.
• Demonstrated correlation between intracranial pressure and visual outcomes.

Conclusions:

• Recognizing ONSCS and the role of intracranial pressure is crucial for targeted treatment.
• Aggressive management of cerebrospinal fluid pressure alongside antifungals is essential.
• Improved understanding leads to better visual outcomes in cryptococcal meningitis.