The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsTable 10-11: Findings Indicative of HIV-Associated Dementia (continued)26 picasCT/MRI Brain Scan Findings• Cerebral atrophy with resultant ventricular enlargement• Diffuse and symmetrical periventricular T-2 abnormalitiesDementia and minor cognitive motor disorder are always diagnoses of exclusion. In late-stagedisease, particularly when CD4 counts are below 200, there are many disorders that may presentwith similar clinical signs, as shown in Table 10-12. 18 Table 10-13 illustrates the distinguishingcharacteristics of progressive multifocal leukoencephalopathy and HIV-associated dementia. 19Laboratory and imaging findings are necessary for accurate diagnosis and appropriateintervention.Table 10-12: Major CNS Manifestations of HIV InfectionCD4DiagnosticDiagnosis Cells/µl Symptoms Signs StudiesBRAINNeurosyphilis Any Headache DementiaCSF: increasedMemory loss Strokeleukocyte count,increased protein;Visual disturbances Meningeal ormyelopathic signs CSF and serum:VDRL, FTACranial nerve palsiesCryptococcus