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BJA Advance Access originally published online on July 25, 2007
British Journal of Anaesthesia 2007 99(4):528-531; doi:10.1093/bja/aem208
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cryptococcus gattii infection causing fulminant intracranial hypertension

J. Bromilow* and T. Corcoran

Intensive Care Unit, Royal Perth Hospital, Wellington St Campus, Perth 6011, Western Australia

* Corresponding author: 23 Lodge Close, Lower Parkstone, Poole, Dorset BH14 9BD, UK. E-mail: brom{at}doctors.org.uk

Cryptococcus neoformans variety gattii (C. gattii) causes infection in predominantly immunocompetent individuals. The majority of cases present with headache due to meningitis and its natural history normally follows an indolent course. We report a fatal case of fulminant cryptococcaemia culminating in severe intracranial hypertension due to C. gattii. Such cases of fulminant disease are rare and highlight a number of important therapeutic and diagnostic considerations. We discuss the atypical nature of this patient's illness, the major complications of C. gattii meningitis and the role of computed tomography (CT) in preventing serious sequelae from lumbar puncture. The management of intracranial hypertension (ICH) in critically ill patients is also reviewed.

Keywords: brain, intracranial pressure; coma, aetiology; cryptococcus, physiology; intracranial hypertension; meningitis, cryptococcal


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