title: Evaluation and management of the swollen optic disk in cryptococcal meningitis.
abstract: Cryptococcal meningitis is the most common and severe form of cryptococcal infection. In addition to infiltrative and inflammatory mechanisms, intracranial hypertension commonly complicates cryptococcal meningitis and may cause significant visual and neurological morbidity and mortality. The mainstays of treatment for cryptococcal meningitis include standard antifungal therapy, management of intracranial hypertension, and treatment of underlying immunosuppressive conditions. Early and aggressive management of intracranial hypertension in accordance with established guidelines reduces the risk of long-term visual and neurological complications and death. Traditional recommendations for treating elevated intracranial pressure in idiopathic intracranial hypertension including acetazolamide, weight loss, and avoiding serial lumbar punctures-are not helpful in cryptococcal meningitis and may be harmful.
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rigi
authors.affiliation: Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Khurrum
authors.initials: K
authors.lastname: Khan
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Stacy V
authors.initials: SV
authors.lastname: Smith
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Ayman O
authors.initials: AO
authors.lastname: Suleiman
authors.affiliation: Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA; Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA; Department of Neurology, Weill Cornell Medicine, New York, New York, USA; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Department of Ophthalmology, University of Texas Medical Branch (UTMB), Galveston, Texas, USA; Section of Ophthalmology, UT MD Anderson Cancer Center (UTMDACC), Houston, Texas, USA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: aglee@houstonmethodist.org.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000188:drug therapy; D009898:Optic Disk / Q000000981:diagnostic imaging*; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013129:Spinal Puncture / Q000379:methods*
chemical_list: D000935:Antifungal Agents
keywords: cryptococcal meningitis; cryptococcosis; elevated intracranial pressure; papilledema