Calvo A, Hernández P, Spagnuolo E, Johnston E
Intensive Care Unit, Hospital Maciel, Montevideo, Uruguay.
Br J Neurosurg. 2003 Oct;17(5):450-5. doi: 10.1080/02688690310001611242.
The incidence of cryptococcosis has risen sharply together with the growing number of patients with Acquired Immunodeficiency Syndrome (AIDS). Cryptococcal meningitis is nowadays the most common intracranial non-viral infection in such cases. One of its most serious complications is intracranial hypertension (ICH), a situation that can lead either to early death, or disabling sequelae. The authors analyse a series of 10 cases of encephalic cryptococcosis with ICH, and describe the clinical course, diagnosis, medical and surgical treatment, and evolution. The physiopathology of ICH in these patients is discussed, proposing placement of a ventriculo-peritoneal shunt as the primary and emergency treatment, even when ventricular enlargement might be absent. Although the present series is certainly small, from the preceding discussion and according to an extensive bibliographical review, our conclusion is that patients with encephalic cryptococcosis and uncontrollable ICH should receive surgical treatment, consisting of an emergency diversion of the CSF, because serial lumbar punctures are not enough to improve the clinical course, that if left to its natural evolution would lead to a fatal outcome in a short time. In spite of the fact that CSF shunts were carried out on immunocompromised patients, no superinfections occurred.
随着获得性免疫缺陷综合征（AIDS）患者数量的增加，隐球菌病的发病率急剧上升。如今，隐球菌性脑膜炎是此类病例中最常见的颅内非病毒感染。其最严重的并发症之一是颅内高压（ICH），这种情况可能导致早期死亡或致残性后遗症。作者分析了一系列10例伴有ICH的脑隐球菌病病例，并描述了其临床过程、诊断、药物和手术治疗以及病情发展。讨论了这些患者ICH的病理生理学，提出即使在可能不存在脑室扩大的情况下，将脑室-腹腔分流术作为主要的紧急治疗方法。尽管本系列病例数量肯定较少，但根据前面的讨论以及广泛的文献综述，我们的结论是，患有脑隐球菌病且ICH无法控制的患者应接受手术治疗，即紧急进行脑脊液分流，因为连续腰椎穿刺不足以改善临床过程，若任其自然发展，短时间内将导致致命后果。尽管脑脊液分流术是在免疫功能低下的患者身上进行的，但并未发生继发感染。
