Clinical neurology and neurosurgery · 2026
Coccidioides meningitis as a cause of low-pressure hydrocephalus: A contemporary case series and management strategy.
СтатьяНазвание и аннотация: Перевод в очереди
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Iyer Sumant, Briggs Robert G, Dallas Jonathan, Guo Liam L, Park Hyoungjin, Cote David J, Bageac Devin, Gogia Angad, Sakowski Melissa, Chen Joseph, Lee Darrin J
Аннотация
OBJECTIVE: Coccidioidal meningitis (CM) is frequently complicated by hydrocephalus, requiring cerebrospinal fluid (CSF) diversion. Loss of ventricular compliance and shunt malfunction can result in low-pressure hydrocephalus (LPH), posing challenges to definitive shunt management. We report our institutional experience using prolonged external ventricular drainage (EVD) at subatmospheric pressures to re-establish ventricular compliance prior to permanent CSF diversion in patients with CM-associated LPH.
METHODS: A retrospective review was performed of 12 adult patients with confirmed CM who underwent EVD placement followed by definitive shunt surgery between 2019 and 2024. Demographic, clinical, radiographic, and operative variables were collected. Ventricular dimensions on computed tomography (CT) both on presentation and postoperatively were measured to assess radiographic response. Primary outcomes included ventricular size reduction and symptom improvement.
RESULTS: Twelve patients (mean age 49.3 ± 13.6 years; 75% male) were included. Of these, 11/12 (91.7%) had a prior shunt history and presented in shunt failure, most commonly due to abdominal pseudocyst formation (6/11, 55%). EVDs were maintained for a mean of 24.9 ± 14.6 days prior to definitive shunting, including 9.8 ± 12.3 days below 0 mmHg to promote subatmospheric drainage. Radiographic analysis demonstrated ventricular size reduction following CSF diversion, with a 26% decrease in mean biventricular frontal horn width (p = 0.006) and a 56% decrease in mean width of the third ventricle (p = 0.002). At a mean follow-up of 4.7 months, all patients had experienced some form of symptomatic improvement, including complete resolution of headaches (5/5, 100%), seizures (5/5, 100%), and visual symptoms (2/2, 100%). Complications occurred in 4/12 (33.3%) patients.
CONCLUSIONS: Prolonged EVD drainage prior to definitive shunting with low-pressure shunt systems is an effective strategy for restoring ventricular compliance in CM-associated LPH, resulting in significant radiographic improvement and favorable clinical outcomes.
METHODS: A retrospective review was performed of 12 adult patients with confirmed CM who underwent EVD placement followed by definitive shunt surgery between 2019 and 2024. Demographic, clinical, radiographic, and operative variables were collected. Ventricular dimensions on computed tomography (CT) both on presentation and postoperatively were measured to assess radiographic response. Primary outcomes included ventricular size reduction and symptom improvement.
RESULTS: Twelve patients (mean age 49.3 ± 13.6 years; 75% male) were included. Of these, 11/12 (91.7%) had a prior shunt history and presented in shunt failure, most commonly due to abdominal pseudocyst formation (6/11, 55%). EVDs were maintained for a mean of 24.9 ± 14.6 days prior to definitive shunting, including 9.8 ± 12.3 days below 0 mmHg to promote subatmospheric drainage. Radiographic analysis demonstrated ventricular size reduction following CSF diversion, with a 26% decrease in mean biventricular frontal horn width (p = 0.006) and a 56% decrease in mean width of the third ventricle (p = 0.002). At a mean follow-up of 4.7 months, all patients had experienced some form of symptomatic improvement, including complete resolution of headaches (5/5, 100%), seizures (5/5, 100%), and visual symptoms (2/2, 100%). Complications occurred in 4/12 (33.3%) patients.
CONCLUSIONS: Prolonged EVD drainage prior to definitive shunting with low-pressure shunt systems is an effective strategy for restoring ventricular compliance in CM-associated LPH, resulting in significant radiographic improvement and favorable clinical outcomes.