Neurologic Psychologic-complications of HIV AIDS

• Meningitis: Crypto (dx w/ CSF; serum CrAg 90% Se), bacterial (inc. Listeria), viral (HSV, CMV, 1° HIV), TB, histo, Coccidio, lymphoma; neurosyphilis (cranial nerve palsies)
• Space-occupying lesions: may present as HA, focal deficits or Δ MS. Workup: MRI, brain bx only if suspect non-Toxo etiology (Toxo sero ⊖) or no response to 2 wk of empiric anti-Toxo Rx (if Toxo, 50% respond by d3, 91% by d14; NEJM 1993;329:995) Etiology Imaging Appearance Diagnostic Studies

Toxoplasmosis

Enhancing lesions, typically in basal ganglia (can be multiple) ⊕ Toxo serology (Se ~85%)

CNS lymphoma

Enhancing ring lesion (single 60% of the time) ⊕ CSF PCR for EBV ⊕ SPECT or PET scan

Progressive multifocal leukoencephalopathy (PML)

Multiple nonenhancing lesions in white matter ⊕ CSF PCR for JC virus

Other: abscess, nocardiosis, crypto, TB, CMV, HIV

Variable Biopsy

• HIV-assoc. dementia: depressive sx, impaired attention/concentration, psychomotor slowing
• Depression: ↑ rates of suicide/depression
• Myelopathy: infxn (CMV, HSV), cord compression (epidural abscess, lymphoma)
• Peripheral neuropathy: meds (esp 1st gen NRTIs), CMV, diabetes