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Hydrocephalus

  • Manish JaiswalEmail author
Chapter

Abstract

Hydrocephalus is an occasional complication of fungal meningitis. The frequency of hydrocephalus varies in different studies. As previous studies have shown, hydrocephalus secondary to fungal meningitis occurs in 9–63% of patients. Delays in the diagnosis and treatment of hydrocephalus are directly related to poor outcome, including various degrees of residual neurological consequences. Various neurological manifestations, including headache, vomiting, visual impairment, mental change, gait ataxia, and deterioration of consciousness, may be associated with progressive hydrocephalus. These may be attributed to the infection itself, to hydrocephalus, or to both. These clinical findings are of little help in establishing the presence of hydrocephalus. However, the presence of headache, visual impairment, mental change, gait ataxia, and deterioration of consciousness should raise the suspicion that hydrocephalus is present. Brain computed tomography and magnetic resonance imaging are useful tools for rapid diagnosis of hydrocephalus. The treatment of patients with fungal meningitis complicated with hydrocephalus is essentially a diversion of ventricular cerebrospinal fluid (CSF) through a ventriculoperitoneal (VP) shunt or external ventricular drainage. The indications and timing for placement of a shunt in patients with fungal meningitis complicating hydrocephalus are not well understood or universally accepted. Most authors suggest early shunt placement for hydrocephalus to avoid irreversible neurological complications. However, in some patients with fungal meningitis and hydrocephalus, diversion of CSF through a VP shunt does not result in any significant improvement. Thus, selecting patients who would benefit from a VP shunt becomes important because use of VP shunts does not result in a good response or outcome if it is associated with a Glasgow Coma Scale score of 8 and below and duration of altered consciousness of more than 48 hours.

Keywords

Hydrocephalus CNS fungal infection Fungal meningitis Ventriculoperitoneal (VP) shunt CNS mycosis 

Abbreviations

ABCD

Amphotericin B colloidal dispersion

ABLC

Amphotericin B lipid complex

AIDS

Acquired immune deficiency syndrome

CNS

Central nervous system

CSF

Cerebrospinal fluid

CT

Computed tomography

FLAIR

Fluid-attenuated inversion recovery

GCS

Glasgow Coma Scale

HIV

Human immunodeficiency virus

ICU

Intensive care unit

MRI

Magnetic resonance imaging

VP shunt

Ventriculoperitoneal shunt

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryKing George’s Medical UniversityLucknowIndia

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