Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis

Bollela, Valdes Roberto; Frigieri, Gustavo; Vilar, Fernando Crivelenti; Junior, Deusdedit Lineu Spavieri; Tallarico, F.J.; Tallarico, G.M.; Andrade, Rodrigo; Haes, Tissiana Marques de; Takayanagui, Osvaldo Massaiti; Catai, AM; Mascarenhas, S.

doi:10.1590/1414-431x20176392

Cited by 22 publications

(21 citation statements)

References 18 publications

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“…Regarding the use of the noninvasive method of measuring the intracranial pressure (ICP) through the brain4care monitor and sensor under conditions that would not be indicated an invasive measurement, findings of important clinical relevance were observed in case studies in infectious diseases such as cryptococcal meningitis in an human immunodeficiency virus-immunosuppressed patient[ 6 ] and even in chronic renal patients. [ 4 ] In both cases, a pathologic ICP patterns (P2 > P1) was present, which could indicate an useful clinical marker of conditions that usually would not have their ICP measured due to invasive standard procedures.…”

Section: Introductionmentioning

confidence: 99%

Intracranial pressure waveform changes in Alzheimer’s disease and mild cognitive impairment

Ribeiro

Cobos

Rabelo³

et al. 2021

Surgical Neurology International

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Background: Alzheimer’s disease (AD) is known to cause an enormous impairment to the quality of life and impact in the health system; meanwhile, studies show that in the coming years, the number of affected individuals will continue to grow. It is also believed that amnestic mild cognitive impairment (MCI) could represent an early symptomatic form of AD, which precedes dementia. Methods: The present study aimed to evaluate the intracranial pressure (ICP) through a noninvasive method in patients with AD and MCI, seeking for differences when compared to healthy elderlies. This is a cross-sectional, correlational, and observational study of a quantitative character, carried out in a Brazilian city, with patients from the ANEC of the UFSCar. Results: It was found a statistically significant difference between the ICP morphology when analyzing the results in patients with AD and MCI, compared to healthy volunteers. It is known that dementias means a progressive disorder that leads to the loss of independency and function of the patient, although, it is believed that it can be found early ICP alterations in these patients. Nevertheless, considering this is an unprecedent study, it was not possible to compare results with previous studies and literatures. However, the study has a limitation related to the sample size; an expansion of it could possibility lead to different findings. Conclusion: The findings through the ICP measurement could indicate an early diagnosis, which would lead to an early treatment and an improvement in the quality of life of patients with AD. Thus, further investigation and widening studies are encouraged.

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Section: Introductionmentioning

confidence: 99%

Intracranial pressure waveform changes in Alzheimer’s disease and mild cognitive impairment

Ribeiro

Cobos

Rabelo³

et al. 2021

Surgical Neurology International

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“…Non-invasive techniques usually face complications based on anatomical diversities; however, the B4C device has been tested and compared to invasive techniques, and it has been proved that it can indicate altered intracranial compliance when the P2/P1 ratio is analyzed. In the case reported, a P2/P1 ratio > 1 was encountered, which indicates poor intracranial compliance, and by the analysis of the case, it can be concluded that it was secondary to the hydrocephalus and shunt malfunction, leading to the regulation of the shunt and relief of the pain (Cardim et al, 2016 ; Vilela et al, 2016 ; Ballestero et al, 2017 ; Bollela et al, 2017 ).…”

Section: Discussionmentioning

confidence: 88%

Case Report: Untreatable Headache in a Child With Ventriculoperitoneal Shunt Managed by Use of New Non-invasive Intracranial Pressure Waveform

Paraguassu

Khilnani²,

Rabelo³

et al. 2021

Front. Neurosci.

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brain4care, a new Food and Drug Administration (FDA)-cleared non-invasive sensor that monitors intracranial pressure waveforms, was used in a 13-year-old girl who presented with untreatable headaches. The patient had a history of craniopharyngioma resection and a ventriculoperitoneal shunt placement 7 years prior to the use of the device. Secondary obstructive hydrocephalus was also a present factor in the case. The hypothesis was that due to the hydrocephalus, the child presented chronic headaches and needed constant readjustment into the ventriculoperitoneal shunt to regulate the cerebrospinal fluid inside her ventricles in order to control the patient's intracranial pressure (ICP). The device was chosen considering the risks to submit a patient into the regular invasive method to measure ICP. It was identified that the device could also indicate altered intracranial compliance due to the ratio between the P1 and P2 amplitudes (P2/P1 ratio > 1).

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“…The pathophysiology of elevated ICP in Cryptococcus neoformans has been hypothesized as the decreased absorption at the arachnoid villi secondary to increased CSF viscosity or microscopic plugs from cryptococcal polysaccharide [12]. There are numerous treatment strategies for the management of increased ICP that range from serial lumbar punctures, external lumbar and ventricular drain placements, and ventricular or lumbar shunting [13]. Medical management of increased ICP with acetazolamide, mannitol, and steroids in HIV-associated cryptococcal meningitis is not recommended [9,11,14].…”

Section: Discussionmentioning

confidence: 99%

A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis

Loye

Gabriel

Zhang

2019

Cureus

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Cryptococcal meningitis is a systemic infection that can be seen in immunosuppressed patients. Altered mental status, somnolence, and obtundation are warning signs of poor prognosis or advanced disease processes. We present a 23-year-old female with a past medical history significant for human immunodeficiency virus (HIV) obtained via vertical transmission who presented to the emergency department (ED) with a gradual onset of worsening headache over 10 days, with blurry vision, photophobia, nausea and vomiting, and progressive memory lapses. Her blood tests, chest plain radiograph, and non-contrast brain computed tomography (CT) were normal. In the ED, she developed a fever of 102°F and became more confused and agitated, with interspersed screaming and yelling. A lumbar puncture (LP) showed elevated white blood cell count and was positive for Cryptococcus neoformans; an opening pressure was unable to be obtained due to patient agitation. Despite prompt intravenous antibiotics and antifungal medications, her short, but tenuous hospital course involved declining mental status, requiring intubation and multiple therapeutic lumbar punctures, with an elevated opening pressure of up to 55 cm H2O. The patient suffered global ischemic encephalopathy and died on hospital day two. This case highlights the rapid decompensation of a young immunocompromised patient with cryptococcal meningitis, as well as the importance of early disease management and consultation to neurology and neurosurgery services. An important paradigm difference for emergency medicine (EM) physicians in the management of increased intracranial pressure (ICP) in patients with cryptococcal meningitis is avoiding acetazolamide, mannitol, and steroids and considering the indication for neurosurgical interventions for severe cryptococcal meningitis.

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Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis

Cited by 22 publications

References 18 publications

Intracranial pressure waveform changes in Alzheimer’s disease and mild cognitive impairment

Intracranial pressure waveform changes in Alzheimer’s disease and mild cognitive impairment

Case Report: Untreatable Headache in a Child With Ventriculoperitoneal Shunt Managed by Use of New Non-invasive Intracranial Pressure Waveform

A Case Report: Tragic Death in a Young Patient with Human Immunodeficiency Virus Due to Cryptococcal Meningitis

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