Raised intracranial pressure in patients with cryptococcal meningitis

Chang 2023Chang 2021Chang 2024

Patients with cryptococcal meningitis require monitoring and treatment for raised intracranial pressure. Management of raised intracranial pressure by drainage or shunting is critical to prevent complications of cryptococcal meningitis, including vision and hearing loss.

Check CSF pressure at baseline and if elevated, a therapeutic lumbar puncture should be repeated regularly (eg 24 to 72 hourly) until the pressure normalises. If CSF pressures remain elevated despite appropriate drug therapy and repeated lumbar punctures, refer to neurosurgery for consideration of ventriculoperitoneal (VP) or lumbar shunting.

If the initial pressure is normal and there are no symptoms or signs of raised intracranial pressure, a therapeutic lumbar puncture should be repeated after 7 days of treatment. Seek expert advice for guidance on the best practice for performing a lumbar puncture.