Question

in pts with cryptococcal meningitis who have increased ICP (manifesting as severe headache, altered sensorium, and blurred vision), initial management is with ___ .

Answer 1

The initial management of increased intracranial pressure in patients with cryptococcal meningitis typically involves therapeutic lumbar puncture or shunting, along with antifungal therapy using amphotericin B and flucytosine, followed by a maintenance phase with fluconazole.

Step-by-step explanation:

In patients with cryptococcal meningitis who present with increased intracranial pressure (ICP), manifesting as severe headache, altered sensorium, and blurred vision, the initial management often includes the reduction of ICP through medical or surgical means, such as therapeutic lumbar puncture or shunt placement.

To directly treat the infection, the combination of the antifungal medications amphotericin B and flucytosine is typically recommended. These drugs are effective against the fungus Cryptococcus neoformans, the causative agent of this form of meningitis, particularly in immunocompromised patients such as those with AIDS. Following the initial treatment, patients usually require a maintenance phase, often with fluconazole for up to 6 months, to completely clear the fungus from their system and prevent relapses.