Neurological manifestations of HIV Flashcards
Main neuroindicator diseases (9)
Meningitis-cryptococcus, viral, TB Toxoplasmosis PML CMV retinitis HSV encephalitis dementia-HAND CIDP transverse myelitis GBS
neuro manifestations of seroconversion-seen in 10% (5)
transient meningoencephalitis (ASEPTIC)-may only involve headache CN palsies e.g. VII neuropathy-AIDP>GBS myelopathy mononeuritis multiplex-vasculitis transverse myelitis
Chronic manifestation of HIV and its features (4)
HAND
dementia+various encephalopathies e.g. PML (JC)
on CT there is atrophy like regular dementia
rare since introduction of cART
Ix for young person presenting w. dementia (3)
HIV test
TFTs
B12
Presentation of cryptococcal meningitis (4)
generalised headache
malaise
SEIZURES
usually no neck stiffness
Ix for cryptococcal meningitis (2)
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
Rx of cryptococcal meningitis (2)
IV amphotericin B + flucytosine
If opening pressure >20 then therapeutic LPs to lower ICP
Other causes of meningitis
Strep pneumoniae
TB (can also cause abscess)
HSV
VZV
Presentation of toxplasmosis (5)
(focal signs) hemiparesis visual deficits dysphasia movement disorders seizures
CT/MRI findings in toxoplasmosis and DDx
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
Rx for toxoplasmosis (3)
pryrimethamine+sulfadiazine or clindamycin for 6mo
if severely raised ICP then give dexamethasone
give lifelong secondary prophylaxis
Cause, Presentation, MRI finding and prognosis of PML (4)
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
Cerebral mass lesions in HIV (2)
PCl (AIDS-defining)
B-cell lymphoma
Cause and Dx of PCL (2)
caused by EBV
Dx via EBV PCR of CSF
Rx of PCL (2)
whole brain irradiation
commence cART
Features of CMV encephalitis (3)
only occurs when CD4<50
rapidly evolving encephalitis
can also cause retinitis, cauda equina and vasculitic neuropathy
Rx of CMV encephalitis
ganciclovir+/-foscarnet
Causes of peripheral neuropathy in HIV (7)
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
Causes of IRIS (5)
toxoplasmosis unmasked by cART TB meningitis cryptococcal meningitis herpes encephalitis (HSV, VZV, CMV) PML
Presentation of IRIS
severe encephalitis-like syndrome
Managment of IRIS
Rx underlying infection
Rx mass effect w. dexamethasone
