Bollela V R, Frigieri G, Vilar F C, Spavieri D L, Tallarico F J, Tallarico G M, Andrade R A P, de Haes T M, Takayanagui O M, Catai A M, Mascarenhas S
Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Braincare Health Technology, São Carlos, SP, Brasil.
Braz J Med Biol Res. 2017 Aug 7;50(9):e6392. doi: 10.1590/1414-431X20176392.
Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema. Significant neurological decline can occur if elevated CSF pressures are inadequately managed. Various treatment strategies to address intracranial hypertension in this setting have been described, including: medical management, serial lumbar punctures, external lumbar and ventricular drain placement, and either ventricular or lumbar shunting. This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI) monitoring in a critically ill HIV-CM patient.
由于颅内压（ICP）并发症，HIV相关隐球菌性脑膜炎（HIV-CM）导致的死亡率和不良神经后遗症仍然很高。超过50%的HIV-CM患者会出现脑脊液（CSF）高开放压。在这些患者的管理中，可能需要反复进行腰椎穿刺引流脑脊液和外部腰椎引流。通常，存在高度的不确定性，关于ICP高血压的临床决策依据往往来自临床表现（头痛、恶心和呕吐）、低格拉斯哥昏迷量表评分和/或眼底视乳头水肿。如果脑脊液压力升高得不到充分管理，可能会发生显著的神经功能衰退。已经描述了在这种情况下解决颅内高压的各种治疗策略，包括：药物治疗、连续腰椎穿刺、外部腰椎和脑室引流放置，以及脑室或腰椎分流。本研究旨在评估无创颅内压（ICP-NI）监测在重症HIV-CM患者中的作用。
