A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS).
A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS).
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DOI：
10.1016/j.idcr.2022.e01554
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发表时间：
2022
期刊：
影响因子：
1.5
通讯作者：
Epstein, Carol
中科院分区：
文献类型：
--
作者：
Guevara, Nehemias;Akande, Abdulrasheed;Chang, Mailing Flores;Atallah, Jane;Epstein, Carol
隐球菌性脑膜炎是艾滋病毒感染者的主要机会性感染。据估计，全球年发病率约为每年100万例，其中撒哈拉以南非洲负担最重。尽管HAART广泛可用和使用，但艾滋病毒相关的隐球菌脑膜炎的死亡率仍然很高。36岁男性，既往有艾滋病病史，CD4细胞计数为35个/mm3，精神状态改变，最初认为与EMS报告的使用结晶甲基苯丙胺有关。然而，在急诊科进行的腰椎穿刺显示脑脊液开口压力升高29 cmH2O，脑脊液和血清隐球菌抗原阳性。患者入院并根据现行IDSA指南开始治疗，但精神状态持续起起落落。在入院的第四天，他抱怨头痛，有癫痫发作，并被紧急送去做脑部CT扫描，结果显示没有任何急性颅内疾病，但在此之前心脏骤停。他被插管送进了重症监护室。颅脑CT随访显示缺氧性脑病，明显脑水肿，基底池完全消失，提示脑幕下疝；他的病情继续恶化，在入院第7天去世。描述一个HIV/AIDS患者隐球菌性脑膜炎继发于颅内压升高的脑死亡病例。解释隐球菌性脑膜炎患者颅内压升高的机制。讨论处理隐球菌性脑膜炎患者颅内压升高的方法。提高医学界对隐球菌性脑膜炎患者颅内压增高及时有效处理重要性的认识。这个病例强调了积极治疗隐球菌性脑膜炎颅内压升高的重要性。它重申需要更多关于治疗性腰椎穿刺的最佳时机和频率，以及使用临时腰椎引流管和脑室造口术来控制这种潜在的致命并发症的数据。
Cryptococcal meningitis is a major opportunistic infection in individuals with HIV. The worldwide annual incidence is estimated to be approximately one million cases per year, with the most significant burden in sub-Saharan Africa. HIV-associated cryptococcal meningitis continues to have a high mortality rate despite widespread availability and use of HAART. 36-year-old male with a past medical history of AIDS and a CD4 count of 35 cells/mm3 presented with altered mental status initially thought to be related to using crystalline methamphetamine as reported by EMS. However, a lumbar puncture performed in the emergency department showed elevated CSF opening pressure of 29 cmH2O and positive CSF and serum cryptococcal antigen. The patient was admitted and commenced treatment according to the current IDSA guideline but continued to have waxing and waning mental status. On the fourth day of admission, he complained of headache, had a witnessed seizure, and was taken emergently for a CT scan of the brain, which was negative for any acute intracranial process, but suffered a cardiac arrest before it could be done. He was intubated and transferred to the intensive care unit. CT brain follow-up showed anoxic encephalopathy, development of marked cerebral edema, and complete effacement of the basilar cisterns, suggestive of downward transtentorial herniation; he continued to deteriorate and expired on the seventh day of admission. Describe a case of brain death secondary to increased intracranial pressure due to cryptococcal meningitis in a patient with HIV/AIDS. Explain the mechanisms of elevation in intracranial pressure in patients with cryptococcal meningitis. Discuss the options for managing elevated intracranial pressure in patients with cryptococcal meningitis. Create awareness in the medical community about the importance of prompt and efficient management of increased intracranial pressure in patients with cryptococcal meningitis. This case highlights the importance of aggressive management of elevated intracranial pressure in cryptococcal meningitis. It reiterates the need for more data regarding the optimal timing and frequency of therapeutic lumbar puncture and the use of temporary lumbar drainage catheters and ventriculostomy to manage this potentially fatal complication.
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影响因子：
3.4
作者：
Jemal M;Deress T;Belachew T;Adem Y
通讯作者：
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DOI：
10.1097/00042560-199802010-00006
发表时间：
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期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY
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