Risk factors and outcomes of cerebrospinal fluid overdrainage in HIV-negative patients with cryptococcal meningitis after the ventriculoperitoneal shunting procedure

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Abstract

Purpose: Shunt procedures used to treat cryptococcal meningitis complicated with hydrocephalus and/or increased intracranial pressure (IICP) could result in cerebrospinal fluid (CSF) overdrainage, thereby presenting therapeutic challenges. Methods: We analyzed the clinical features and neuroimaging findings after the ventriculoperitoneal (VP) shunt procedure in 51 HIV (Human Immunodeficiency Virus)-negative patients with cryptococcal meningitis, to assess the risk factors associated with post-shunt CSF overdrainage. Results: Symptomatic CSF overdrainage occurred in 12% (6/51) of patients with cryptococcal meningitis who underwent the shunt procedure. Rapid deterioration of neurological conditions was found in 6 patients after the shunt procedure was performed, including disturbed consciousness, quadriparesis, and dysphasia in 5 patients and severe ataxia in 1. The mean duration of CSF overdrainage after the shunting procedure was 2–7 days (mean 4 days). The mean interval between meningitis onset to shunting procedure remained independently associated with CSF overdrainage, and the cut-off value for predicting CSF overdrainage in interval between meningitis onset to shunting procedure was 67.5 days. Conclusions: CSF overdrainage after the VP shunt procedure is not rare, especially in patients with a high-risk of cryptococcal meningitis who also have a prolonged duration of hydrocephalus and/or IICP.

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Hung, C. W., Lin, W. C., Chang, W. N., Su, T. M., Kung, C. T., Tsai, N. W., … Lu, C. H. (2018). Risk factors and outcomes of cerebrospinal fluid overdrainage in HIV-negative patients with cryptococcal meningitis after the ventriculoperitoneal shunting procedure. Journal of Microbiology, Immunology and Infection, 51(4), 545–551. https://doi.org/10.1016/j.jmii.2017.06.002

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