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MBBS 3: Internal Medicine > HIV and Neurology > Flashcards

HIV and Neurology Flashcards

1
Q

What is the central nervous system?

A

consists of the brain and spinal cord
Note: Both brain and spinal cord are enclosed in the meninges

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2
Q

What is the peripheral nervous system?

A

consists of the nerves and ganglia outside of the brain and spinal cord

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3
Q

What is a lumbar puncture?

A

is a procedure in which a needle is inserted into the spinal canal to collect cerebrospinal fluid (CSF) to help diagnosing e.g. meningitis

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4
Q

HIV neurological focal lesions causes?

A
  1. toxoplasmosis
  2. tuberculoma
  3. cryptococcoma
  4. pyogenic abscess
  5. lymphoma
  6. progressive multifocal leukoencephalopathy
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5
Q

HIV neurological diffuse disease causes?

A
  1. cryptococcal meningitis
  2. tuberculous meningitis
  3. CNS syphilis
  4. HIV dementia
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6
Q

Diagnosing focal lesions?

A

CT scan

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6
Q

What is the problem with diagnosing ‘neurological’ HIV?

A
  1. CSF results are sometimes not helpful
  2. imaging studies are rarely diagnostic
  3. brain biopsy is invasive
    Therefore: empiric management is often necessary – anywhere in the world
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6
Q

Diagnosing diffuse disease?

A

LP

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7
Q

What are seizures?

A

Seizures are characterized by loss of consciousness and involuntary movements

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8
Q

Ddx for seizures in HIV neurology?

A
  1. Toxoplasmosis
  2. intracerebral involvement of disseminated TB (brain tuberculoma or TB meningitis)
  3. brain abscesses
  4. cryptococcal and bacterial meningitis and intracerebral tumors (e.g. CNS lymphoma)
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9
Q

Two key things to ALWAYS remember in the management of HIV infected patients with neurology?

A
  1. HIV infection does not prevent the development of a non-HIV related problem, so consider “normal causes”
  2. Opportunistic problems are related to the CD4 (+) cell count
    Note: If the count is > 200-300, the problem is probably not related to the HIV infection
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10
Q

At what CD4 count do we consider a person immunocompromised?

A

CD4 count <200

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11
Q

What is toxoplasmosis?

A

One of the most common space occupying lesions especially in a person with a CD4 count <200 (usually < 100)

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12
Q

Etiology of Toxoplasmosis?

A

infection with the Toxoplasma gondii parasite found in cat feces and contaminated food like meat
- can also be caused by reactivation of a previous disease

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13
Q

Pesentation of toxoplasmosis?

A

sub-acute and focal

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14
Q

Most common cause of seizures in HIV patients?

A

toxoplasmosis

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15
Q

Describe the CSF of toxoplasmosis infected patient?

A

non specific

16
Q

Diagnosis of toxoplasmosis?

A
  1. On CT scan multiple ring enhancing lesions are seen (1/3 single lesion)
  2. The best diagnostic test is response to treatment as usually the response happens within 10-14 days
17
Q

Treatment of toxoplasmosis?

A

Treatment: high-dose bactrim (4 tabs bd) for 28 days, followed by three months of 2 tabs bd
NB: bactrim is a combination of the antibiotics sulfamethaxazole and trimethoprim

18
Q

Bactrim can be used as a prophylaxis for?

A
  1. toxoplasmosis
  2. malaria
  3. PCP
  4. diarrhea
19
Q

Etiology of cryptococcosis and TB?
Treatment?

A

Cryptococcosis and tuberculosis more frequently cause meningitis infections, but in individual cases they can also cause focal lesions in the brain
- Treatment is similar to CM and TBM

20
Q

What is a bacterial brain abscess?
Treatment?

A

a focal, intra-cerebral infection which develops into a collection of pus
- Treatment : Broad-spectrum antibiotic or even a combination of antibiotics should be given e.g. ceftriaxone plus metronidazole

21
Q

What is a primary CNS lymphoma?
Treatment?

A

Primary CNS lymphoma is a cerebral mass lesion seen in patients with advanced HIV disease (usually CD4 <50 cells)
Treatment: is not very effective and prognosis is poor

22
Q

What is meningitis?

A

If there is an inflammation of the meninges (meningitis)

23
Q

Features of menigitis?

A
  1. headache
  2. neck stiffness
  3. altered mental status
  4. photophobia
  5. character changes
24
Q

Causes of meningitis?

A
  1. bacterial
  2. fungal
  3. viral
  4. mycobacterial
25
Q

CSF results for bacterial meningitis?

A
  1. increased polymorphs
  2. mildly increased lymphocytes
  3. increased proteines
  4. decreased glucose
  5. negative serum CrAg
26
Q

CSF results for mycobacterial meningitis?

A
  1. mildly increased polymorphs
  2. increased lymphocytes
  3. increased protein
  4. decreased protein
  5. negative serum CrAg
27
Q

CSF results in viral meningitis?

A
28
Q

CSF results in fungal meningitis?

A
  1. mildly increased polymorphs
  2. increased lymphocytes
  3. increased protein
  4. decreased glucose
  5. positive serum CrAg
29
Q

Common symptoms of stroke in HIV patients?

A

Symptoms of stroke (e.g. hemiparesis, aphasia) in younger patients are seen relatively commonly in HIV positive patients

30
Q

Risk factors for stroke in HIV?

A

Traditional risk factors such as hypertension or diabetes are often absent

31
Q

What causes stroke like symptoms?

A

opportunistic infection as a cause of the symptoms
1. intracranial TB
2. syphilis
3. VZV
4. cryptococcal meningitis

32
Q

HIV associated disease that causes stroke?

A

HIV-associated cerebral vasculitis has been reported as the etiology of stroke in up to 20% of young HIV-positive stroke patients large South African series

33
Q

Spinal cord disease and HIV?

A
  • Spinal TB should be considered especially in upper motor neuron disease (=> X-ray spine). If there are suggestive signs of TB, TB treatment has to be started
  • If TB is improbable because hyperreflexia and radiological signs are absent, a clinically carefully monitored treatment trial with steroids seems warranted
34
Q

Peripheral neuropathy and HIV?

A
  • Usually occurs in HIV+ patients at late stages with varying severity
  • Poorly understood aetiology (could be related to malnutrition and resultant wasting of peripheral nerves, or neurotoxic effect of cytokines), also secondary to NRTI use e.g. AZT
35
Q

Clinical features of peripheral neuropathy?

A
  1. Burning pain, paresthesia
  2. Decrease ankle jerk
  3. Normal strength but can progress to muscle weakness
36
Q

Treatment of peripheral neuropahty?

A

Symptomatic Tx: Ibu, Carbamazepine, Amitryptillin

37
Q

CNS syphilis and HIV?

A

Syphilis can involve the CNS in two stages:
Secondary (aseptic meningitis)
Tertiary (meningovascular, dementia, tabes dorsales)

38
Q

Diagnosing CNS syphilis?

A

Our syphilis test is for plasma only
No CSF test is available => if positive in plasma and clinic fits=> treat!

MBBS 3: Internal Medicine (72 decks)

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