How is increased intracranial pressure due to CNS cryptococcosis treated in HIV infection?

Updated: Jan 08, 2020
  • Author: Felicia J Gliksman, DO, MPH; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Opening pressure is elevated to greater than 25cm H20 in 60–80% of patients with AIDS and cryptococcal CNS infection. [8, 9]  This is probably due to obstruction of the basal meninges or impaired CSF absorption. Since increased intracranial pressure is a prognostic factor whose correction leads to symptomatic improvement, this must be managed aggressively.

In the absence of obstructive hydrocephalus or risk of herniation, increased pressure (>25cm H2 O) can be relieved by serial lumbar punctures. For those who cannot tolerate repeated lumbar punctures, a lumbar drain or ventriculostomy should be considered. A lumbar-peritoneal shunt or ventriculoperitoneal shunt may be indicated as well. Decreasing intracranial pressure can rapidly improve headache, nausea, and vomiting. Mannitol and corticosteroids have no proven benefit and are not recommended. [12]  Acetazolamide should not be used for treatment of increased intracranial pressure as it may cause hyperchloremic acidosis. [17]


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