Catastrophic visual loss due to Cryptococcus neoformans meningitis.
We have reviewed our experience with 17 of our own patients with cryptococcal meningitis and 32 cases from the literature. Although this complication is an uncommon event, patients with cryptococcal meningitis may develop visual loss in the absence of other ocular lesions (endophthalmitis or cryptoc...
| Publicado en: | Medicine Vol. 72; no. 4; pp. 207 - 225 |
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| Autores principales: | , , , , |
| Formato: | case study Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
1993 Jul
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104787059&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104787059 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00257974 2S6 jtl: Medicine issn: 00257974 maglogo: N pubinfo: dt: 1993 Jul vid: 72 iid: 4 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 104787059 104787059 NLM8341139 2011146554 10.1097/00005792-199307000-00001 NLM8341139 104787059 ppf: 207 ppct: 18 formats: tig: atl: Catastrophic visual loss due to Cryptococcus neoformans meningitis. aug: au: Rex, J H Larsen, R A Dismukes, W E Cloud, G A Bennett, J E affil: Center for Infectious Diseases, University of Texas Health Sciences Center, Houston 77030. sug: subj: Meningitis, Cryptococcal Complications Vision Disorders Etiology Adolescence Adrenal Cortex Hormones Therapeutic Use Adult Antifungal Agents Therapeutic Use Female Intracranial Pressure Male Middle Age Optic Nerve Diseases Complications Intracranial Hypertension Complications Spinal Puncture Time Factors Vision Disorders Physiopathology Vision Disorders Therapy Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: We have reviewed our experience with 17 of our own patients with cryptococcal meningitis and 32 cases from the literature. Although this complication is an uncommon event, patients with cryptococcal meningitis may develop visual loss in the absence of other ocular lesions (endophthalmitis or cryptococcomas in the visual pathway) that could explain the visual symptoms. There are 2 distinct patterns of visual loss: rapid visual loss and slow visual loss. Rapid visual loss is characterized by onset of profound visual loss over a period as short as 12 hours before or early in the course of therapy and a clinical syndrome that is strongly suggestive of optic neuritis. Direct invasion of the optic nerve by C. neoformans is demonstrated by cases in this and other reports. Slow visual loss is characterized by slow but progressive visual loss which typically begins later during therapy and may be due to the effects of increased intracranial pressure. While the initial deficit may be mild, patients with slow visual loss can progress to severe visual loss over weeks to months. The only factors that appear to predict either pattern of visual loss are the presence of papilledema, an elevated CSF opening pressure, and a positive CSF India ink preparation. In the 25 visual loss patients for whom data were available for all 3 items, 10 (40%) were positive for all 3, as opposed to only 4 of 114 (3.5%) from a reference group of cryptococcal meningitis patients without visual loss (p < 0.00001). The only therapeutic measures with any degree of consistent success were those directed at reducing intracranial pressure. When begun early and used aggressively, such therapy halted and sometimes even reversed the course of visual loss, particularly in the slow visual loss group. Corticosteroids did not appear to be of value in the small number of patients who received them. pubtype: Academic Journal doctype: case study Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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