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Raised ICP in a child with cryptococcal meningitis: CT evidence of a distal CSF block
J F Schoeman1, E M Honey, D B Loock
1Department of Paediatrics and Child Health, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa.
Insights
Raised intracranial pressure in cryptococcal meningitis can be caused by a distal cerebrospinal fluid (CSF) block. Ventriculoperitoneal shunting normalized CSF spaces, suggesting this blockage in a pediatric case.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Raised intracranial pressure (ICP) is a common complication of cryptococcal meningitis.
- The underlying cause of severe ICP in this condition remains poorly understood, especially with normal initial CT scans.
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.