To investigate theoretical basis for improving the management of human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM).

The clinical data of an HIV-infected patient with severe CM admitted to our hospital in 2015 were analyzed, retrospectively. A literature review was performed to discuss the management of the elevated intracranial pressure (ICP) in HIV-associated CM.

The reported case had extremely high ICP with severe vision impairment that he could not recognize anything except for a perception of strong light with blunted pupillary light response. The patient sequentially received lumbar drainage and lumboperitoneal shunt to control the elevated ICP that his vision finally returned to premorbid level. A literature view found that elevated ICP in HIV-associated CM was mainly caused by the obstruction to cerebrospinal fluid reabsorption. Current strategies to control the elevated ICP including serial therapeutic lumbar puncture drainages, external lumbar or ventricular drainage, and permanent lumboperitoneal or ventriculoperitoneal shunt. Although mannitol was commonly used in China, it was not recommended in many other countries.

Stringent control of elevated ICP was very important for the management of HIV-associated CM. When severe vision impairment occurs, early cerebrospinal fluid drainage or shunting to maximally control elevated ICP, may help to prevent permanent vision loss.