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Raised Intracranial Pressure

  • Hasan Emre Aydın
  • Ismail Kaya
Chapter

Abstract

Fungal infections of the central nervous system (CNS) are widely observed in healthy hosts (Cryptococcus, Coccidioides, Histoplasma, Blastomyces, and Sporothrix) or in immunocompromised hosts by opportunistic pathogens (Candida, Aspergillus, Zygomycetes, and Trichosporon) (Redmond et al. 2007). Chronic meningitis or meningoencephalitis syndrome, brain abscess, rhino-cerebral syndrome, and rare fungal ventriculitis are among the clinical syndromes of CNS fungal infections and are frequently observed among children in clinical practice. CNS fungal infections should be considered in patients who have serous nasal flow, orbital pain, seizures, increased intracranial pressure, and meningitis with or without chronic febrile encephalitis. Initial characteristics of these CNS fungal infections are usually non-specific symptoms such as general fatigue, chronic fever, headache, subacute dementia, episodes, and neurologic deficits (Teive et al. 2008). Increased intracranial pressure (ICP) is responsible for both early mortality and auditory, visual, and cognitive symptoms of meningitis caused by fungal infections (Sun et al. 2004).

Keywords

nervous system Cerebrospinal fluid Diagnosis Fungal infections Intracranial hypertension Physiopathology Raised intracranial pressure 

Abbreviations

CNS

Central nervous system

CSF

Cerebrospinal fluid

EVD

Extraventricular drainage

ICP

Intracranial pressure

ONS

Optic nerve sheath

PI

Pulsatility index

VA

Ventriculoatrial

VP

Ventriculoperitoneal

References

  1. Akopian G, Gaspard DJ, Alexander M. Outcomes of blunt head trauma without intracranial pressure monitoring. Am Surg. 2007;73(5):447–50.PubMedGoogle Scholar
  2. Albeck MJ, Børgesen SE, Gjerris F, Schmidt JF, Sørensen PS. Intracranial pressure and cerebrospinal fluid outflow conductance in healthy subjects. J Neurosurg. 1991;74(4):597–600.CrossRefGoogle Scholar
  3. Alperin N, Lee SH, Bagci AM. MRI measurements of intracranial pressure in the upright posture: the effect of the hydrostatic pressure gradient. J Magn Reson Imaging. 2015;42:1158–63.  https://doi.org/10.1002/jmri.24882.CrossRefPubMedGoogle Scholar
  4. Altunbaşak Ş. Şuuru Kapalı Hastaya Yaklaşım ve Kafa İçi Basınç Artışı Sendromu (KİBAS) Türkiye Klinikleri. J Pediatr. 2008;4(4):55–66.Google Scholar
  5. Antinori S, Ridolfo AL, Gianelli E, Piazza M, Gervasoni C, Monforte AA. The role of lumbar puncture in the management of elevated intracranial pressure in patients with AIDS associated cryptococcal meningitis. Clin Infect Dis. 2000;31:130910.CrossRefGoogle Scholar
  6. Bellner J, Romner B, Reinstrup P, Kristiansson K-A, Ryding E, Brandt L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004;62(1):45–51.CrossRefGoogle Scholar
  7. Bolela VR, Frigieri G, Vilar FC, Spaiveri DL, Tallarico FJ, Tallaico GM, et al. Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis. Braz J Med Biol Res. 2017;50(9):e6392.CrossRefGoogle Scholar
  8. Cherian J, Atmar RL, Gopinath SP. Shunting in cryptococcal meningitis. J Neurosurg. 2016;125:177–86.  https://doi.org/10.3171/2015.4.JNS15255.CrossRefPubMedGoogle Scholar
  9. Corti M, Solari R, Cangelosi D, Dominguez C, Yampolsky C, Negroni R, et al. Sudden blindness due to bilateral optic neuropathy associated with cryptococcal meningitis in an AIDS patient. Rev Iberoam Micol. 2010;27:207–9.CrossRefGoogle Scholar
  10. Day JN, Chau TT, Wolbers M, Mai PP, Dung NT, Mai NH, et al. Combination antifungal therapy for cryptococcal meningitis. N Engl J Med. 2013;368:1291–302.CrossRefGoogle Scholar
  11. Denning DW, Armstrong RW, Lewis BH, Stevens DA. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am J Med. 1991;91:26772.CrossRefGoogle Scholar
  12. Gjerris F, Brennum J. The cerebrospinal fluid, intracranial pressure and herniation of the brain. In: Paulson OB, Gjerris F, Sorensen PS, editors. Clinical neurology and neurosurgery. Copenhagen, Denmark: FADL’s Forlag Aktieselskab; 2004. p. 179–96.Google Scholar
  13. Jarvis JN, Bicanic T, Loyse A, Namarika D, Jackson A, Nussbaum JC, et al. Determinants of mortality in a combined cohort of 501 patients with HIV-associated cryptococcal meningitis: implications for improving outcomes. Clin Infect Dis. 2014;58:73645.CrossRefGoogle Scholar
  14. Lee SC, Dickson DW, Casadevall A. Pathology of cryptococcal meningoencephalitis: analysis of 27 patients with pathogenetic implications. Hum Pathol. 1996;27:83947.CrossRefGoogle Scholar
  15. Loyse A, Wainwright H, Jarvis JN, Bicanic T, Rebe K, Meintjes G, et al. Histopathology of the arachnoid granulations and brain in HIV-associated cryptococcal meningitis: correlation with cerebrospinal fluid pressure. AIDS. 2010;24:40510.CrossRefGoogle Scholar
  16. Pappas PG. Management cryptococcal meningitis is about handling the pressure. Clin Infect Dis. 2005;40:480–2.CrossRefGoogle Scholar
  17. Perfect JR, Dismukes WE, Dromer F, Graybill JR, Hamill RJ, Harrison TS, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Disease Society of America. Clin Infect Dis. 2010;50:291–322.CrossRefGoogle Scholar
  18. Redmond A, Dancer C, Woods ML. Fungal infections of the central nervous system: a review of fungal pathogens and treatment. Neurol India. 2007;55:251–9.CrossRefGoogle Scholar
  19. Sekhon MS, McBeth P, Zou J, Qiao L, Kolmodin L, Henderson WR, et al. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care. 2014;21(2):245–52.CrossRefGoogle Scholar
  20. Speck V, Staykov D, Huttner HB, Sauer R, Schwab S, Bardutzky J. Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus. Neurocrit Care. 2011;14(2):208–15.CrossRefGoogle Scholar
  21. Steiner L, Andrews P. Monitoring the injured brain: ICP and CBF. Br J Anaesth. 2006;97(1):26–38.CrossRefGoogle Scholar
  22. Sun HY, Hung CC, Chang SC. Management of cryptococcal meningitis with extremely high intracranial pressure in HIV-infected patients. Clin Infect Dis. 2004;38(12):1790–2.  https://doi.org/10.1086/421272.CrossRefPubMedGoogle Scholar
  23. Teive H, Carsten AL, Iwamoto FM, Almedia SM, Munhoz RP, Werneck LC, et al. Fungal encephalitis following bone marrow transplantation: clinical findings and prognosis. J Postgrad Med. 2008;54:203–5.CrossRefGoogle Scholar
  24. Xu L, Liu J, Zhang Q, Li M, Liao J, Kuang W, et al. Triple therapy versus amphotericin B plus flucytosine for the treatment of non-HIV- and nontransplant-associated cryptococcal meningitis: retrospective cohort study. Neurol Res. 2018.  https://doi.org/10.1080/01616412.2018.1447319.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Hasan Emre Aydın
    • 1
  • Ismail Kaya
    • 1
  1. 1.Department of NeurosurgeryKutahya Health Sciences UniversityKütahyaTurkey

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