title: Lumbar drainage for control of raised cerebrospinal fluid pressure in cryptococcal meningitis: case report and review.
abstract: Raised intracranial pressure in the absence of ventricular dilatation is common in cryptococcal meningitis and associated with increased mortality. We report the case of a patient with HIV-associated cryptococcal meningitis, who developed increasing CSF pressure and visual impairment on therapy despite serial lumbar punctures. Insertion of a temporary lumbar drain controlled the opening pressure and resulted in full visual recovery. The advantages and necessary precautions with this approach are reviewed, and alternative protocols for the use of lumbar drains discussed.
authors.affiliation: Division of Infectious Diseases, Department of Cellular and Molecular Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. kmacsween@doctors.org.uk
authors.forename: Karen F
authors.initials: KF
authors.lastname: Macsween
authors.forename: Tihana
authors.initials: T
authors.lastname: Bicanic
authors.forename: Annemarie E
authors.initials: AE
authors.lastname: Brouwer
authors.forename: Henry
authors.initials: H
authors.lastname: Marsh
authors.forename: Derek C
authors.initials: DC
authors.lastname: Macallan
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Harrison
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D015170:Cerebrospinal Fluid Pressure; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D003840:Deoxycholic Acid / Q000008:administration & dosage; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004338:Drug Combinations; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D005437:Flucytosine / Q000008:administration & dosage; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D013129:Spinal Puncture / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole; D005437:Flucytosine