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Related Experiment Videos

Catastrophic visual loss due to Cryptococcus neoformans meningitis

J H Rex1, R A Larsen, W E Dismukes

  • 1Center for Infectious Diseases, University of Texas Health Sciences Center, Houston 77030.

Medicine
|July 1, 1993
PubMed
Summary

Cryptococcal meningitis can cause rapid or slow visual loss, often without other ocular lesions. Managing intracranial pressure is key to preserving vision.

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Ophthalmology

Background:

  • Cryptococcal meningitis is an opportunistic infection, particularly in immunocompromised individuals.
  • Visual loss is an uncommon but serious complication of cryptococcal meningitis.
  • The exact mechanisms and patterns of visual loss require further elucidation.

Observation:

  • Reviewed 17 patient cases and 32 literature cases of cryptococcal meningitis with visual loss.
  • Identified two distinct patterns: rapid visual loss (optic neuritis) and slow visual loss (intracranial pressure effects).
  • Observed direct optic nerve invasion by *C. neoformans* in rapid visual loss.

Findings:

  • Rapid visual loss presents acutely, often suggesting optic neuritis with direct fungal invasion.

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  • Slow visual loss progresses over weeks to months, linked to elevated intracranial pressure.
  • Papilledema, elevated CSF opening pressure, and positive CSF India ink tests predict visual loss (40% vs 3.5%).

    • Implications:

    • Early and aggressive management of intracranial pressure can halt or reverse visual loss.
    • Corticosteroids showed no significant benefit in the studied cases.
    • Prompt diagnosis and intervention are crucial for visual preservation in cryptococcal meningitis.