ICP in cryptococcal meningitis

Q: 42 years old male with known history of AIDS and previous cryptococcal meningoencephalitis is brought to ED by his roommate with clouding of sensorium and ataxia. On exam patient is found to have visual and hearing loss, and papilledema. Lumbar puncture (LP) was planned. What is considered to be the increased Intra Cranial Pressure (ICP) in cm of H2O? - select one

A) >10 

B) >20 

C) >30

D) >40 

Answer: B

One of the essential procedures required in patients with AIDS and suspected cryptococcal meningoencephalitis is LP to measure ICP.

High ICP is one of the hallmark of cryptococcal meningoencephalitis. It is probably due to increased vascular permeability secondary to cytokine-induced inflammation. Also, clogging of arachnoid villi with fungal antigen and/or yeasts, plays role by impairment of CSF resorptive function.

Pressure above >20 cm of H2O is considered as high ICP.

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References:

1. Chang CC, Harrison TS, Bicanic TA, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis 2024.

2. The World Health Organization. Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents, and children. http://apps.who.int/iris/bitstream/handle/10665/260399/9789241550277-eng.pdf;jsessionid=7A37044AC579D4A69EBBBF0B47BC60AF?sequence=1 (Accessed on May 19, 2024).

3. Claus JJ, Portegies P. Reversible blindness in AIDS-related cryptococcal meningitis. Clin Neurol Neurosurg 1998; 100:51.

4. Pappas PG. Managing cryptococcal meningitis is about handling the pressure. Clin Infect Dis 2005; 40:480.