Persistently elevated intracranial pressure in cryptococcal meningitis- 76 therapeutic lumbar punctures

Area of Science:

• Infectious Diseases
• Neurology
• Public Health

Background:

• Cryptococcal meningitis is a leading cause of adult meningitis in sub-Saharan Africa, strongly associated with HIV/AIDS.
• Increased intracranial pressure (ICP) is a frequent and serious complication of cryptococcosis, necessitating prompt and effective management.
• Therapeutic lumbar punctures (LPs) are a cornerstone in managing elevated ICP in cryptococcal meningitis.

Observation:

• A case of cryptococcal meningitis with persistently elevated ICP is presented.
• The patient underwent an exceptionally high number of therapeutic lumbar punctures (LPs) over an extended period (76 LPs in 46 days).
• Despite the intensive intervention, the patient experienced a favorable clinical outcome.

Findings:

• Serial therapeutic lumbar punctures (LPs) can be effective in managing persistently elevated intracranial pressure (ICP) in cryptococcal meningitis.
• Aggressive and prolonged LP management, though unusual in frequency, can lead to positive patient outcomes.
• This case underscores the potential benefits of persistent therapeutic interventions for complex cases.

Implications:

• Highlights the critical role and potential efficacy of serial therapeutic lumbar punctures (LPs) in managing severe cryptococcal meningitis with elevated intracranial pressure (ICP).
• Suggests that clinicians should consider aggressive, prolonged LP strategies even in cases with extreme procedural frequency.
• Emphasizes the importance of individualized patient management in resource-limited settings facing high burdens of HIV/AIDS and opportunistic infections like cryptococcosis.