hiv neurology

7/24/2019 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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