Related Experiment Videos
Venous sinus stenting worsening in fulminant intracranial hypertension secondary to Cryptococcus gattii: lessons
Aliakbar Netterwala1, Priyadarshini Padaki2, Jayanthi Savio2
1Neurology, St John's Medical College Hospital, Bengaluru, Karnataka, India aliakbar12n@gmail.com.
Abstract:
Idiopathic intracranial hypertension (IIH) is a diagnosis of exclusion, and venous sinus stenosis may coexist with IIH, making careful evaluation for secondary causes essential. We report an immunocompetent man in late 30s who presented with headache and visual blurring. Brain MRI demonstrated features of raised intracranial pressure with transverse sinus stenosis. Lumbar puncture revealed high opening pressure and IIH was presumed. The patient underwent left transverse-sigmoid sinus stenting with transient improvement, followed by recurrent headache and rapid visual deterioration. Repeat angiography demonstrated new venous narrowing, prompting stent extension. Re-evaluation of cerebrospinal fluid cultures grew Cryptococcus gattii on Sabouraud dextrose agar. Induction therapy with amphotericin B plus flucytosine, followed by fluconazole maintenance, resulted in complete resolution of headache. This case highlights that C. gattii meningitis can mimic IIH, and that cerebrospinal fluid cryptococcal evaluation is essential before confirming a diagnosis of IIH or proceeding with venous sinus stenting.
Related Concept Videos
Cryptococcal Meningitis
Brain Abscess l: Introduction
Venous Thrombosis III: Interprofessional Care
Increased Intracranial Pressure ll: Pathophysiology
Increased Intracranial Pressure l: Introduction
Cerebral Edema ll: Pathophysiology