hiv neurology
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HIV NEUROLOGY
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CENTRAL NERVOUS SYSTEM DISORDERS ASSOCIATEDWITH HIV
General ConsiderationsTable Common nerolo!i" "om#li"ation o$ HIV "lassi%ed b& t'e sta!e in ('i"' ea"' o""rs
EARLY STAGE )CD *+, -.. /
HIV Menin!itis )a"te "on0ersion s&ndrome/
S'in!les )0ari"ella1 2oster/
A"te in3amator& dem&elinatin! #ol&nero#at'& )AID4/
MIDDLE STAGE )CD*+ 5..1-../
Distal Sensor& 4ol&nero#at'& )DS4/
HIV1 asso"iated dementia )HIVD/
HIV asso"iated neroms"lar (ea6ness s&ndrome
Mononero#at'& mlti#le7
HIV asso"iated m&o#at'&
LATE STAGE
CNS To7o#lasmosis
Crto"o""al menin!itis4rimar& CNS l&m#'oma )4CNSL/
4ro!ressi0e mlti$o"al le6oen"e#'alo#at'&
HIV asso"iated m&elo#at'&
Vari"ella 8oster 0as"litis
CMV 0entri"litis or #ol&radi"litis ) CD*+ 9 :../
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CRY4TOCOCCAL MENINGITIS
Essential o$ Dia!nosis:; A late sta!e "om#li"ation o$ HIV
in$e"tion
5; Sba"te onset o$ 'eada"'e
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CLINICAL >INDINGS
Table Essential "lini"al in$ormation ('en
$ormin! HIV related di?erential dia!nosis Dration o$ HIV in$e"tion Histor& o$ HIV related illness
CD*+ "ell "ont )"rrent and nadir/
HIV RNA le0el Medi"ation se and ad'eren"e
Antiretro0iral a!ents< "rrent and #ast
C'emo#ro#'&la"ti" a!ents )Sl$amet'o7asole1trimet'o#rim 3"ona2ole< a"&"lo0ir/
Serm To7o#lasma I!G antibod& stats
Serm s'ilis serolo!&
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TO@O4LASMOSIS O> THE CENTRAL NERVOUS SYSTEM
Essential o$ Dia!nosis:; A late sta!e "om#li"ation o$ HIV in$e"tion
5; >o"al nerolo!i" de%"its< sba"teen"e#'alo#at'&< and $e0er
=; Mlti#le rin!1en'an"in! lesions on MRI
*; 4resen"e o$ serm To7o#lasma I!Gantibod&
-; Clini"al and radiolo!i" im#ro0ement (it'#&rimet'amine and eit'er sl$adia2ine o$"indam&"in
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COM4ARISON O> CNS TO@O4LASMOSIS AND 4RIMARYLYM4HOMA
Toxoplasmosis PCNSLLo"ation asal Gan!lia
Gra& W'ite Bn"tion4eri0entri"lar
Nmber o$ lesions Mlti#le Solitar& , mlti#le
En"'an"ement
#attern
Rin! Hetero!enos or
'omo!enos
Edema Moderate to mar6ed Variable
T5 (ei!'ted ima!e Herintense Isotense to 'otense
Di?sion (ei!'tedima!e
Usall& Hointense O$ten 'erintense
MR #er$sion De"reased In"reased
MR S#e"tros"o#& Mar6edl& ele0atedla"tate
Mar6edl& ele0ated"'oline
S4ECT T'alim COLD no t'alim#ta6e
HOT In"reasedt'alim #ta6e
Ot'er To7o I!G Antibodi EV DNA am#li%ed b&
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TREATMENT
4&rimet'amine
Sl$adia2ine
>oli" a"id Clindam&"in
Corti"osteroid
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4ROGNOSIS
Com#lete Re"o0er& s'old bee7#e"ted;
To7o#lasmosis "erebri "an re"r
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