Yes! You realize now that the unifying diagnosis of Cryptococcal meningitis explains this patient's neurologic presentation. She's actually been having plateau waves.
Plateau waves are "intermittent episodes of neurologic dysfunction that result from sudden rises in intracranial pressure" (Posner et al 2019). The name is derived from the ICP waveform that you'd get with invasive monitoring. Is this patient at high risk of intracranial hypertension? YES! She has leptomeningeal disease and inflammation that impairs CSF resorption. In retrospect, it makes more sense that her episodic fixed and dilated pupils were actually from episodic rises in her ICP. But, things have cascaded to the point where the ICP elevation has reached a critical point and is now sustained. We need to act quickly to save her brain from further damage.
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