Management of Neurologic Diseases

  • Authors: David M. Simpson, MD; Jessica Robinson-Papp, MD (More Info)
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 4/1/16 (What's New)

Summary

Introduction

  • Neurologic complications of HIV remain common despite the availability of effective ART
  • HIV-infected patients should be evaluated for possible neurologic symptoms
  • OIs and primary CNS lymphoma occur almost exclusively in patients with marked immunosuppression
  • Other disorders, such as HIV-associated distal symmetric polyneuropathy and HIV-associated dementia, occur at any CD4+ cell count
  • Referral
    • Patients presenting with suspected neurologic conditions should be referred to a neurologist
    • Diagnostic testing should focus on the leading differential diagnoses
    • Common diagnostic studies include neuropsychological testing, neuroimaging, blood tests, CSF examination, electroencephalography, and nerve conduction studies and electromyography

HIV-Associated Neurocognitive Disorders

    Epidemiology and Clinical Presentation
    • HAND is the most common CNS complication of HIV, although severe forms are rare
      • Presents with slowly progressive cognitive decline, with or without depression, withdrawal, and psychomotor slowing
    • Parkinsonian symptoms such as decreased facial expression, mildly increased muscle tone, frontal release signs, and mild slowing of gait are common[...

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