Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis
Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis
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DOI：
10.1086/313603
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发表时间：
2000-01-01
影响因子：
11.8
通讯作者：
Dismukes, W
中科院分区：
文献类型：
--
作者：
Graybill, JR;Sobel, J;Dismukes, W
本研究旨在描述脑脊液 (CSF) 压力正常或升高的艾滋病和隐球菌性脑膜炎患者的实验室和临床病程。数据是从一项随机多中心准因素 III 期研究中回顾性获得的，该研究比较了两性霉素 B 联合或不联合氟胞嘧啶在隐球菌性脑膜炎的初级治疗中的情况。在治疗前和治疗两周时测量脑脊液压力。反复腰椎穿刺引流脑脊液并减压，基线开放压最高（大于或等于250 mm H2O）的患者以脑脊液中隐球菌荚膜多糖抗原滴度较高为特征；脑脊液印墨涂片阳性的情况更为频繁；更频繁出现头痛、脑膜痉挛、视乳头水肿、听力丧失和病理反射。接受抗真菌治疗后，那些脑脊液压力降低>10毫米或没有变化的患者在2周时比压力增加>10毫米的患者有更频繁的临床反应（P
This study was undertaken to characterize the laboratory and clinical course of patients with AIDS and cryptococcal meningitis who had normal or elevated cerebrospinal fluid (CSF) pressure. Data were obtained retrospectively from a randomized multicenter quasifactorial phase III study comparing amphotericin B with or without flucytosine in primary treatment of cryptococcal meningitis. CSF pressure was measured before treatment and at 2 weeks. Repeated lumbar punctures were done to drain CSF and to reduce pressure, Patients with the highest baseline opening pressures (greater than or equal to 250 mm H2O) were distinguished by higher titers of cryptococcal capsular polysaccharide antigen in CSF; more frequently positive India ink smears of CSF; and more frequent headache, meningismus, papilledema, hearing loss, and pathological reflexes. After receiving antifungal therapy, those patients whose CSF pressure was reduced by >10 mm or did not change had more frequent clinical response at 2 weeks than did those whose pressure increased >10 mm (P