II. Epidemiology

  1. Common complication in late AIDS

III. Pathophysiology

  1. Spectrum from subtle deficits to HIV-Associated Dementia
  2. Higher severity (including Dementia) with decreasing CD4 Counts
  3. Involves three neurologic domains
    1. Cognitive (memory, concentration, planning, comprehension)
    2. Behavioral (apathy, depression, Agitation)
    3. Motor (Incoordination, unsteady gait, Tremor)

IV. Signs

  1. Early
    1. Impaired concentration
    2. Forgetfulness
    3. Slowed cognitive function
  2. Late
    1. Impaired rapid movements
    2. Hyperreflexia
    3. Release reflexes
    4. Weakness
    5. Ataxia
    6. Spasticity
    7. Bladder and bowel Incontinence
    8. Myoclonus

VI. Imaging: Brain MRI findings

  1. Cerebral atrophy
  2. Patchy, diffuse increased white matter signal intensity
    1. Excludes other causes

VII. Labs: CSF Exam

  1. Mildly elevated Protein
  2. Mild Pleocytosis, predominance of mononuclear cells

IX. Management

  1. Antiretroviral drugs
    1. May improve neuropsychiatric performance
    2. May alleviate symptoms

X. Complications

  1. Poor compliance with Antiretroviral therapy (with risk of resistance)
  2. Decreased functional capacity

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