ELEVATION OF INTRACRANIAL-PRESSURE IN ACUTE AIDS-RELATED CRYPTOCOCCAL MENINGITIS

被引:25
|
作者
MALESSA, R
KRAMS, M
HENGGE, U
WEILLER, C
REINHARDT, V
VOLBRACHT, L
RAUHUT, F
BROCKMEYER, NH
机构
[1] UNIV ESSEN GESAMTHSCH KLINIKUM,DERMATOL KLIN,D-45147 ESSEN,GERMANY
[2] UNIV ESSEN GESAMTHSCH KLINIKUM,INST NEUROPATHOL,D-45147 ESSEN,GERMANY
[3] UNIV ESSEN GESAMTHSCH KLINIKUM,INST KLIN CHEM,D-45147 ESSEN,GERMANY
来源
CLINICAL INVESTIGATOR | 1994年 / 72卷 / 12期
关键词
CRYPTOCOCCAL MENINGITIS; ACQUIRED IMMUNE-DEFICIENCY SYNDROME; INTRACRANIAL PRESSURE ELEVATION; INTRACRANIAL PRESSURE ELEVATION PATHOPHYSIOLOGY; CEREBROSPINAL FLUID DRAINAGE;
D O I
10.1007/BF00577748
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Prior to the AIDS-era, elevation of intracranial pressure was known to be a typical complication of cryptococcal meningitis associated with an increased risk of early death. In AIDS-patients, however, the prevalence and clinical significance of this complication are as yet unclear. We analysed clinical features and courses, CSF findings, serological results and neuroimaging scans in acute cryptococcal meningitis in eight patients with AIDS. Five showed symptoms and signs compatible with raised intracranial pressure, which was life-threatening in one and the most probable cause of death in another. Serial monitoring of intracranial pressure together with repeated CSF analysis revealed that severe intracranial pressure elevation in AIDS related cryptococcal meningitis can occur in spite of effective antimycotic treatment, does not depend on an increased CSF/serum osmolality ratio or CSF overproduction and can be associated with normal cranial computed tomography and magnetic resonance imaging findings. Our data support the hypothesis that CSF reabsorption failure plays the crucial role in the pathophysiological mechanism. External lumbar drainage may be of benefit in selected cases of acute AIDS related cryptococcal meningitis with persisting life threatening elevation in intracranial pressure and normal computed tomogram.
引用
收藏
页码:1020 / 1026
页数:7
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