Neurological manifestations of HIV

Question 1

Main neuroindicator diseases (9)

Answer 1

Meningitis-cryptococcus, viral, TB
Toxoplasmosis
PML
CMV retinitis
HSV encephalitis
dementia-HAND
CIDP
transverse myelitis
GBS

Question 2

neuro manifestations of seroconversion-seen in 10% (5)

Answer 2

transient meningoencephalitis (ASEPTIC)-may only involve headache CN palsies e.g. VII
neuropathy-AIDP>GBS
myelopathy
mononeuritis multiplex-vasculitis
transverse myelitis

Question 3

Chronic manifestation of HIV and its features (4)

Answer 3

HAND
dementia+various encephalopathies e.g. PML (JC)
on CT there is atrophy like regular dementia
rare since introduction of cART

Question 4

Ix for young person presenting w. dementia (3)

Answer 4

HIV test
TFTs
B12

Question 5

Presentation of cryptococcal meningitis (4)

Answer 5

generalised headache
malaise
SEIZURES
usually no neck stiffness

Question 6

Ix for cryptococcal meningitis (2)

Answer 6

MUST DO CT BEFORE LP even if there are no focal lesions since there may be SOL from toxoplasmosis>^ICP>herniation
Cryptococcal CSF similar to viral but ^^ opening pressure
CSF analysis with India ink staining shows cryptococcus

Question 7

Rx of cryptococcal meningitis (2)

Answer 7

IV amphotericin B + flucytosine

If opening pressure >20 then therapeutic LPs to lower ICP

Question 8

Other causes of meningitis

Answer 8

Strep pneumoniae
TB (can also cause abscess)
HSV
VZV

Question 9

Presentation of toxplasmosis (5)

Answer 9

(focal signs)
hemiparesis
visual deficits
dysphasia
movement disorders
seizures

Question 10

CT/MRI findings in toxoplasmosis and DDx

Answer 10

Multiple ring-enhancing lesions which are occur around the basal ganglia and grey-white matter interface
cerebral lymphoma also presents with ring-enhancing lesions but are mainly peri-ventricular

Question 11

Rx for toxoplasmosis (3)

Answer 11

pryrimethamine+sulfadiazine or clindamycin for 6mo
if severely raised ICP then give dexamethasone
give lifelong secondary prophylaxis

Question 12

Cause, Presentation, MRI finding and prognosis of PML (4)

Answer 12

caused by JC virus, usually latent in male prostate
presents with slowly evolving focal neurological deficits
MRI shows asymmetrical patchy demyelination (doesn’t fit w. any vascular pattern)
deficit is permanent

Question 13

Cerebral mass lesions in HIV (2)

Answer 13

PCl (AIDS-defining)

B-cell lymphoma

Question 14

Cause and Dx of PCL (2)

Answer 14

caused by EBV

Dx via EBV PCR of CSF

Question 15

Rx of PCL (2)

Answer 15

whole brain irradiation

commence cART

Question 16

Features of CMV encephalitis (3)

Answer 16

only occurs when CD4<50
rapidly evolving encephalitis
can also cause retinitis, cauda equina and vasculitic neuropathy

Question 17

Rx of CMV encephalitis

Answer 17

ganciclovir+/-foscarnet

Question 18

Causes of peripheral neuropathy in HIV (7)

Answer 18

distal sensory peripheral neuropathy

demyelinating peripheral neuropathies e.g. CID, GBS

vasculitic neuropathy (mononeuritis multiplex)

diffuse infiltrative lymphocytosis syndrome

MND-like syndrome

CMV

Drug-induced e.g. isoniazid

Question 19

Causes of IRIS (5)

Answer 19

toxoplasmosis unmasked by cART
TB meningitis
cryptococcal meningitis
herpes encephalitis (HSV, VZV, CMV)
PML

Question 20

Presentation of IRIS

Answer 20

severe encephalitis-like syndrome

Question 21

Managment of IRIS

Answer 21

Rx underlying infection

Rx mass effect w. dexamethasone