ELEVATION OF INTRACRANIAL-PRESSURE IN ACUTE AIDS-RELATED CRYPTOCOCCALMENINGITIS

Prior to the AIDS-era, elevation of intracranial pressure was known to be a typical complication of cryptococcal meningitis associated with an increased risk of early death. In AIDS-patients, however, the preva lence and clinical significance of this complication are as yet unclea r. We analysed clinical features and courses, CSF findings, serologica l results and neuroimaging scans in acute cryptococcal meningitis in e ight patients with AIDS. Five showed symptoms and signs compatible wit h raised intracranial pressure, which was life-threatening in one and the most probable cause of death in another. Serial monitoring of intr acranial pressure together with repeated CSF analysis revealed that se vere intracranial pressure elevation in AIDS related cryptococcal meni ngitis can occur in spite of effective antimycotic treatment, does not depend on an increased CSF/serum osmolality ratio or CSF overproducti on and can be associated with normal cranial computed tomography and m agnetic resonance imaging findings. Our data support the hypothesis th at CSF reabsorption failure plays the crucial role in the pathophysiol ogical mechanism. External lumbar drainage may be of benefit in select ed cases of acute AIDS related cryptococcal meningitis with persisting life threatening elevation in intracranial pressure and normal comput ed tomogram.