Moodley Anand, Rae William, Bhigjee Ahmed
Department of Neurology, Greys Hospital, South Africa.
Department of Neurology, University of KwaZulu-Natal, South Africa.
South Afr J HIV Med. 2015 Oct 16;16(1):305. doi: 10.4102/sajhivmed.v16i1.305. eCollection 2015.
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 electrophysiological manifestations of Cryptococcus-induced visual loss and review the mechanisms involved.
永久性视力丧失是隐球菌性脑膜炎一种严重但可预防的并发症。需要早期积极控制脑脊液压力并联合抗真菌治疗。从历史上看，隐球菌性脑膜炎导致视力丧失的机制包括视神经炎和视乳头水肿。因此，视力丧失治疗的基础一直是类固醇治疗和降低颅内压，但没有明确的指导方针。随着视神经高分辨率磁共振成像的应用，出现了另一种机制，即由颅内压严重升高和视神经周围间隙真菌负荷引起的视神经鞘间隔综合征（ONSCS）。对这些机制的深入理解以及对颅内压升高所起重要作用的认识，使得能够采取更有针对性的治疗措施并取得更好的治疗效果。在本系列90例合并感染HIV的隐球菌性脑膜炎患者中，我们呈现了隐球菌所致视力丧失的临床和电生理表现，并对其中涉及的机制进行了综述。
