Prolonged external ventricular drainage to treat Cryptococcus gattii induced intracranial hypertension without hydrocephalus.

Ameya S Kamat,Kelvin Woon

doi:10.7759/cureus.92

Abstract

The use of prolonged external ventricular drainage to treat uncontrollable intracranial hypertension in patients with cerebral cryptococcomas without hydrocephalus is unique and remains largely unreported. This condition, however, can be life-threatening. Early diagnosis and cerebrospinal fluid diversion techniques are important and are essential to survival and neurological function. We report a case of uncontrollable intracranial hypertension without hydrocephalus in a 21-year-old man which was successfully managed by prolonged external ventricular drainage.

Highlights

The increasing incidence of cryptococcal meningitis associated with immunocompromised patients is well-documented, especially since the onset of the AIDS epidemic
We report a case of uncontrollable intracranial hypertension without hydrocephalus in a 21-yearold man which was successfully managed by prolonged external ventricular drainage
The patient's symptoms improved after lumbar puncture but recurred 48 hours later requiring serial LP's which demonstrated raised intracranial pressure (ICP)

Summary

Introduction

The increasing incidence of cryptococcal meningitis associated with immunocompromised patients is well-documented, especially since the onset of the AIDS epidemic. The use of prolonged external ventricular drainage to treat uncontrollable intracranial hypertension in patients with cerebral cryptococcomas without hydrocephalus is unique and remains largely unreported. Magnetic resonance imaging (MRI) of the brain was performed with and without contrast This demonstrated multiple cerebral lesions with surrounding oedema and lack of enhancement, in keeping with cryptococcomas (Figure 2). The patient's symptoms improved after lumbar puncture but recurred 48 hours later requiring serial LP's which demonstrated raised intracranial pressure (ICP). After EVD removal, the patient had returned to his pre-morbid baseline and his ventricular size appeared normal on CT scan

Discussion

Disclosures

Findings

Tang LM