Medicine - Presbyterian 20 September 1994 CNS Manifestations of AIDS the chart below is ordered such that the more focal neurological presen tations proceed progressively from 1 eft-to-righ! SERN eerie 1 ‘Neoplasms ‘cerebrovascular HIV encephalopathy ow ‘Toxoplasma 2° CxS lymphoma Infarction Atypical aseptic meningitis | nev 12 | cryptococeus Metastatic lymphoma Henorrhage vacuolar myelopathy Herpes/vav | Histoplagea Metastatic Kaposi's sarcoma | vasculitis Aspergillus coceiaioides Aerenoniun Bhizopue mycobacterium Listeria monocye Nocardia Clinical Features zn rv encephalopathy (previously known as AIDS dementia complex) one sees a progressive subcortical dementia without the symptoms including mood and personality changes overlap with those of depressive disorders. In addition, of mania or schizophrenia. gait, paraparesis and encephalopathy. increased Motor symptoms such muscle tone focal neurological signs. Some of HIV encephalopathy can result in a delirium with features as hyperreflexia, suggest the spastic or ataxic diagnosis of HIV Subcortical vs. cortical dementia The distinction as outlined in this table is subtle but important -_pubeortical Cortical N h io aphasia impaired recall > recognition ed Jed until late isproportionately affected aphasia early Recall and recogni: Impaired Involved early Impairment consistent w/ other involvenes Normal until late in disease jon impaired unconcerned Buthymic Articulate until lave Upright Normal until late Normal absent Slowed early Apathetic, inert Depressea Dysarthrse || bowed or extended i : impaired “Motor peed and cast rol slowea “Aavebtithous movements Chores, tremor tics, éystonia Differentic meningitis which occurs syndrome with delirium, latter syndrome, mononuclear pleocytosis atrophy, Shortly after HIV Diagnosis xv encephalopathy needs to be differentiated from HIV aseptic infection and appears meningeal signs and facial palsies. the CSF may reveal a slightly elevated protein concentration and a flu-like with the Furthermore, In HIV encephalopathy MRI and CT studies may show cortical ventricular enlargement and areas of demyelination. usually a generalized slowing of the EEG. In addition, there is Pathology rv is both neurotrophic as well as immunotrophic and within the CNS is believed to primarily in astrocytosis, perivascular vacuolation and demyelinat. cells fect glial lymphocytes cuffing, ion. However, particularly astrocyte: encephalopathy one sees multinucleated giant cells, With HIV diffuse and white matter microglial nodules, cortical atrophy, dementia most reliably correlates with the presence of HIV encephalitis as measured by intra-CNS viral burden. References Kaplan & sadock (2996), Smapeis of Paycnsatsy, 7th a6, YE the Pachologice! correlate ot Denaatia in Acauired