机构:[1]Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe Road, Guangzhou 510630, Guangdong, China.中山大学附属第三医院[2]Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China.中山大学附属第三医院[3]Department of Neurology, Foshan Chinese Medicine Hospital, Foshan 528000, Guangdong, China.
Persistent and uncontrollable intracranial hypertension (ICH) and difficulty in reducing Cryptococcus count are severe problems in cryptococcal meningitis (CM) patients. The therapeutic effects of ventriculoperitoneal shunts (VPS) in non-HIV CM patients are not fully known, and the procedure is somewhat unusual. Here, our study offers a review to investigate the role of VPS in non-HIV CM.
We retrospectively collected data on 23 non-HIV CM patients with and without ventriculomegaly from 2010 to 2016. Their demographic data, clinical manifestations, cerebrospinal fluid (CSF) features and outcomes were analysed.
We found that non-HIV CM patients without ventriculomegaly were older, had earlier treatment times and had shorter symptom durations than CM patients with ventriculomegaly. In both groups, headache, vomiting, fever and loss of vision were the most common clinical features. CSF pressure and Cryptococcus count were significantly decreased after operation. VPS could provide sustained relief from ICH symptoms such as headache. 13% of patients had poor outcomes because of serious underlying disease, while 87% of patients had good outcomes.
The use of a VPS is helpful in decreasing ICH and fungal overload in non-HIV CM patients, and VPS should be performed before CM patients present with symptoms of severe neurological deficit.
基金:
The study was supported by National Science Foundation (No. 81271327),
Guangdong Science Foundation of Guangdong Province (NO.2015A03013167),
Science&technology Project of Guangzhou (NO.201510010251).