Permanent visual loss is a devastating yet preventable complication of cryptococcal meningitis. Early and aggressive management of cerebrospinal fluid pressure in conjunction with antifungal therapy is required. Historically, the mechanisms of visual loss in cryptococcal meningitis have included optic neuritis and papilloedema. Hence, the basis of visual loss therapy has been steroid therapy and intracranial pressure lowering without clear guidelines. With the use of high-resolution magnetic resonance imaging of the optic nerve, an additional mechanism has emerged, namely an optic nerve sheath compartment syndrome (ONSCS) caused by severely elevated intracranial pressure and fungal loading in the peri-optic space. An improved understanding of these mechanisms and recognition of the important role played by raised intracranial pressure allows for more targeted treatment measures and better outcomes. In the present case series of 90 HIV co-infected patients with cryptococcal meningitis, we present the clinical and electrophysiological manifestations of Cryptococcus-induced visual loss and review the mechanisms involved.

中文翻译：

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与艾滋病毒有关的隐球菌性脑膜炎的视力丧失：一个病例系列及其相关机制的回顾。

永久性视力丧失是隐球菌脑膜炎的毁灭性但可预防的并发症。需要早期和积极地处理脑脊液压力并结合抗真菌治疗。历史上，隐球菌性脑膜炎的视力丧失机制包括视神经炎和乳头水肿。因此，视力减退疗法的基础是类固醇疗法和颅内压降低而没有明确指南。随着对视神经的高分辨率磁共振成像的使用，出现了另一种机制，即由颅内压的严重升高和视神经周围空间的真菌负荷引起的视神经鞘层室综合征（ONSCS）。对这些机制的更好的理解以及对颅内压升高所起的重要作用的认识，使治疗方法更有针对性，疗效更好。在本病例系列的90例HIV合并感染的隐球菌性脑膜炎患者中，我们介绍了隐球菌引起的视力丧失的临床和电生理表现，并回顾了所涉及的机制。