May He Rest in Peace

May He Rest in Peace

Neurologic Complications of AIDS Medical Knowledge Fiesta 2012 Paul K. King MD pkingmd@yahoo.com

Objectives definition of HIV/AIDS what are the neurologic complications of AIDS how are neurologic complications diagnosed how are neurologic complications treated

What IS HIV/AIDS? Human Immunodeficiency Virus = the virus Acquired Immune deficiency syndrome = advanced stage of infection with the virus AIDS is an immune system disease that can affects the nervous system in many ways

How Dose Aids Affect The Nervous System? Inflammatory damage to cortex, subcortical white matter, and spinal cord, peripheral nerves Demyelination immune/inflammatory Direct damage Opportunistic infection Cancers Drugs

Symptoms Pain seizures Shingles Spinal cord problems Fever Visual loss Developmental delays loss of milestones

Clinical Conditions HIV Dementia/Aids Dementia Complex ADC HIV Sensory Neuropathy HIV Myelopathy Progressive Multifocal Leukoencephalopathy PML Primary Central nervous System Lymphoma Toxoplasmosis Crytococcal Meningitis Cytomegalovirus Encephalitis and Radiculitis

Clinical Conditions Herpes virus: encephalitis, shingles Neurosyphilis Psychological and Neuropsychological TB Meningitis Cerebrovascular Disease and Stroke

Evaluation and Treatment A brain CT scan or MRI with and without contrast is indicated for all patients presenting with altered mental status, headaches, seizures, or focal neurologic signs. MRI is clearly the superior technique but is not available universally. Lumbar Puncture Spect PET Scan

If this initial imaging study is normal, or shows atrophy or focal signal abnormalities but no mass lesion diagnostic consideration should be given to meningitides, AIDS dementia complex (ADC), or progressive multifocal leukoencephalopathy.

Biopsy?? Decompression???? Diagnosis?? One or Multiple Mass lesions Toxoplasmosis Serology Negative Mass Effect or Herniation

HIV Dementia Increasing forgetfulness Poor concentration Loss of interest Poor short term memory Behavior change Rule out other causes Improved with HAART

HIV Sensory Neuopathy 30 % develop neuropathy Dying back axonopathy Burning Feet Decreased sensation position and vibration Can be HAART related + EMG

HIV Myelopathy Weak Hands legs Loss of bowel and bladder Spastic gait HAART and Rehab Oral or interthecal baclofen

PML Progressive Multifocal Leukoencephalopathy 3% of patients withaids progressive accumulation of neurologic deficits cognitive impairment, motor weakness,gait disturbance, coordination difficulties, visual loss

PML Demyelinating disorder Reactivation of latent papovavirus - JC strain diagnosis made by clinical exam and MRI treatment: combination antiretrovirals alpha interferon

Primary CNS Lymphoma 2% of AIDS patients headaches, focal neurologic deficits, seizures, change in mental status Single or multiple enhancing CT, or MRI lesions; thallium SPECT CSF Epstien Barr Whole brain radiation, and HAART = better prognosis

CNS Lymphoma Spect scan MRI

CNS Toxoplasmosis 3-12 % of AIDS patients Reactivation of latent toxoplasmosis gondi - intracellular parasite fever, altered mentation, seizures, focal neurologic deficits symptoms develope over a few days Multiple contrast enhancing lesions on CT, and MRI -?? lymphoma, bacterial brain abscess, metastatic?? Pyramethamine, and Sulfadizine 1-4 weeks, and

Cryptoccal Neoformans ubiquitious yeast 5% of AIDS patients; less since antifungal treatment Cryptococcal Meningitis Fever, Nausea, Vomiting, Cognitive Dysfunction Headache, Visual loss CSF cryptoccal antigen 100% sensitive and specific Amphotericin B, 5- flurocytosine Lumbar spinal drainage vs multiple LPs reverses visual impairment if done early

CMV Cytomegalovirus encephalitis and Radiculitis common pathogen in advanced AIDS CD 4count < 100 cells/mm3 2% of AIDS patients confusion, disorientation, memory loss acute /subacute rapid progression CSF: CMV DNA, PCR ganciclovir or forscarnet, or double therapy

CMV Cytomegalovirus encephalitis and Radiculitis 2% of aids patients Cognitive Dysfunction Headache subacute onset: paraparesis, paresthesias, sacral pain, sphincter dysfunction

Thank You Neurologic Complications of AIDS