Denning D W, Armstrong R W, Lewis B H, Stevens D A
Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128.
Am J Med. 1991 Sep;91(3):267-72. doi: 10.1016/0002-9343(91)90126-i.
Increased intracranial pressure has been a noteworthy problem in some of our patients with cryptococcal meningitis and acquired immunodeficiency syndrome (AIDS), and this appears to be a feature observed in patients with cryptococcal meningitis reported in the literature. Whereas most attention of clinicians is presently focused on optimizing the antifungal regimen, so as to improve on high failure rates in cryptococcal meningitis in AIDS, little attention has been paid to the problem of intracranial hypertension. We argue that visual loss and some of the cases of death early after the onset of chemotherapy may be related to high cerebrospinal fluid (CSF) pressure, regardless of antifungal therapy. The possible pathophysiologic mechanisms are discussed, and we postulate that the mechanism is reduced CSF outflow possibly due to increased outflow resistance, not necessarily accompanied by prominent cerebral edema. Optimal therapy of this complication is not yet established, but some measures that may be helpful are ventricular shunting, frequent high-volume lumbar punctures, and possibly glucocorticoids.
颅内压升高在我们的一些患有隐球菌性脑膜炎和获得性免疫缺陷综合征（AIDS）的患者中一直是一个值得关注的问题，这似乎是文献中报道的隐球菌性脑膜炎患者所具有的一个特征。目前，临床医生大多将注意力集中在优化抗真菌治疗方案上，以改善艾滋病患者隐球菌性脑膜炎的高失败率，而对颅内高压问题关注甚少。我们认为，化疗开始后早期出现的视力丧失和部分死亡病例可能与高脑脊液（CSF）压力有关，而与抗真菌治疗无关。本文讨论了可能的病理生理机制，我们推测其机制是脑脊液流出减少，可能是由于流出阻力增加，不一定伴有明显的脑水肿。这种并发症的最佳治疗方法尚未确立，但一些可能有帮助的措施包括脑室分流、频繁进行大容量腰椎穿刺，以及可能使用糖皮质激素。
