DR Medhat MRCP

سؤال هام جدا Neurological complications of HIV
Generalised neurological disease
Focal neurological lesions
1. Encephalitis (CMV,HIV,HSV) 1. Toxoplasma.
2. Cryptococcus meningitis. 2. 1ry CNS lymphoma.
3. Progressive multifocal leukoencephalopathy (PML). 3. TB.
4. AIDS dementia complex.
A. Generalised neurological disease :
1) Encephalitis :
May be due to CMV or HIV itself
HSV encephalitis but is relatively rare in the context of HIV
CT: oedematous brain
2) Cryptococcus :
Most common fungal infection of CNS
Headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit
CSF: high opening pressure, India ink test positive.
CT: meningeal enhancement, cerebral oedema.
Meningitis is typical presentation but may occasionally cause a space
occupying lesion
3) Progressive multifocal leukoencephalopathy (PML):
Widespread demyelination.
Due to infection of oligodendrocytes by JC virus (a polyoma DNA virus).
Symptoms : subacute onset , behavioural changes, speech, motor, visual
impairment
CT: single or multiple lesions, no mass effect, don't usually enhance. MRI is
better - high-signal demyelinating white matter lesions are seen
4 ) AIDS dementia complex :
Caused by HIV virus itself.
Symptoms : behavioural changes, motor impairment
CT: cortical and subcortical atrophy.
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