Original Research

Visual loss in HIV-associated cryptococcal meningitis: A case series and review of the mechanisms involved

Anand Moodley, William Rae, Ahmed Bhigjee
Southern African Journal of HIV Medicine | Vol 16, No 1 | a305 | DOI: https://doi.org/10.4102/sajhivmed.v16i1.305 | © 2015 Anand Moodley, William Rae, Ahmed Bhigjee | This work is licensed under CC Attribution 4.0
Submitted: 17 December 2014 | Published: 16 October 2015

About the author(s)

Anand Moodley, Department of Neurology, Greys Hospital, South Africa; Department of Neurology, University of KwaZulu-Natal, South Africa, South Africa
William Rae, Department of Medical Physics, University of The Free State, South Africa
Ahmed Bhigjee, Department of Neurology, University of KwaZulu-Natal, South Africa

Abstract

Permanent visual loss is a devastating yet preventable complication of cryptococcal meningitis. Early and aggressive management of cerebrospinal fluid pressure in conjunction with antifungal therapy is required. Historically, the mechanisms of visual loss in cryptococcal meningitis have included optic neuritis and papilloedema. Hence, the basis of visual loss therapy has been steroid therapy and intracranial pressure lowering without clear guidelines. With the use of high-resolution magnetic resonance imaging of the optic nerve, an additional mechanism has emerged, namely an optic nerve sheath compartment syndrome (ONSCS) caused by severely elevated intracranial pressure and fungal loading in the peri-optic space. An improved understanding of these mechanisms and recognition of the important role played by raised intracranial pressure allows for more targeted treatment measures and better outcomes. In the present case series of 90 HIV co-infected patients with cryptococcal meningitis, we present the clinical and electrophysiological manifestations of Cryptococcus-induced visual loss and review the mechanisms involved.

Keywords

cryptococcal meningitis; optic nerve; optic nerve sheath compartment syndrome; papilloedema; optic nerve infiltration

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