n Southern African Journal of HIV Medicine - Visual loss in HIV-associated cryptococcal meningitis : a case series and review of the mechanisms involved : original research
|Article Title||Visual loss in HIV-associated cryptococcal meningitis : a case series and review of the mechanisms involved : original research|
|Journal||Southern African Journal of HIV Medicine|
|Affiliations||1 Greys Hospital, 2 University of KwaZulu-Natal, 3 University of KwaZulu-Natal and 4 University of The Free State|
|Publication Date||Apr 2015|
|Pages||1 - 9|
Permanent visual loss is a devastating yet preventable complication of cryptococcal meningitis. Early and aggressive management of cerebrospinal fluid pressure in conjunction with antifungal therapy is required. Historically, the mechanisms of visual loss in cryptococcal meningitis have included optic neuritis and papilloedema. Hence, the basis of visual loss therapy has been steroid therapy and intracranial pressure lowering without clear guidelines. With the use of high-resolution magnetic resonance imaging of the optic nerve, an additional mechanism has emerged, namely an optic nerve sheath compartment syndrome (ONSCS) caused by severely elevated intracranial pressure and fungal loading in the peri-optic space. An improved understanding of these mechanisms and recognition of the important role played by raised intracranial pressure allows for more targeted treatment measures and better outcomes. In the present case series of 90 HIV co-infected patients with cryptococcal meningitis, we present the clinical and electro-physiological manifestations of Cryptococcus-induced visual loss and review the mechanisms involved.
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