Normal Pressure Hydrocephalus in a Human Immunodeficiency Virus Type 1 Patient (original) (raw)
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Case Reports in Neurology
We describe a previously healthy 21-year-old man who presented acutely with signs and symptoms of raised intracranial pressure (ICP). Lumbar puncture yielded an elevated opening pressure and an acellular CSF analysis. Radiological images showed bilateral flattening of the posterior eye globes and an empty sella turcica. His serum HIV antigen/antibody was reactive. We provide a review of published cases that have been labeled as idiopathic intracranial hypertension (IIH) in HIV-infected patients, addressing the appropriateness of labeling such cases as truly idiopathic. We also discuss the importance of a thorough clinical evaluation of raised ICP in those who do not fulfil the typical IIH demographic.
Journal of Clinical Microbiology, 1992
Cerebrospinal fluid (CSF) specimens from 63 patients with different seven'ties of human immunodeficiency virus (HIV-1) infection, including asymptomatic virus carriers, were examined for the presence of HIV-1 by using polymerase chain reaction (PCR) and virus isolation. Polyadenylated RNA, presumably associated with virus particles, was extracted and reverse transcribed, and the pol region was amplified in a nested PCR. Virus could be detected in 90% of the CSF specimens examined by PCR, and data on isolation of virus from CSF were in agreement with these figures. In fact, when several CSF specimens from the same individual were studied, HIV-1 could be isolated from 80%o of the patients. The presence of the viral RNA in CSF was independent of the clinical stage of infection and of neurological symptoms. These results show that the spread of HIV-1 to the brain represents an early event during infection and occurs in the majority of asymptomatic individuals.
HIV-Associated Vacuolar Encephalomyelopathy
Open Forum Infectious Diseases, 2019
We report a case of HIV-associated vacuolar encephalomyelopathy with progressive central nervous system dysfunction and corresponding vacuolar degeneration of the spinal cord, cranial nerves, and brain, the anatomic extent of which has not previously been described. Vacuolar myelopathy classically presents as a spinal syndrome with progressive, painless gait disturbance in the setting of advanced HIV and AIDS. Vacuolar involvement of the brain and cranial nerves, as illustrated in this case report, is a newly described variant of this condition that we term vacuolar encephalomyelopathy.
A study of clinical profile of HIV positive patients with neurological manifestations
HIV & AIDS Review, 2011
Background: Central nervous system (CNS) is among the most frequent and serious target of HIV infection in patients with profound immunosuppression. CNS problems occur mainly due to either primary pathologic process of HIV or secondary to opportunistic infection and neoplasm. Aims and objectives: To study the clinical and investigation profile in diagnosis of HIV patients with CNS manifestation. To correlate CD 4 levels with CNS opportunistic infections. Materials and methods: A prospective observational non-randomized clinical study of 50 HIV infected patients, showing clinical evidence of CNS involvement, admitted in tertiary care centre was done. Detail clinical history and CNS examination was carried out. CD 4 count was measured using standard flowcytometry. Investigations like MRI brain/electromyography-nerve conduction studies/cerebrospinal fluid (CSF) examination were done as and when required for diagnosis. Results: HIV induced primary CNS illness was present in 30% while 70% cases were due to secondary CNS manifestation mainly due to opportunistic infection. Most common primary illness was distal symmetric polyneuropathy (DSPN) (22%), followed by Aids dementia complex (ADC) (4%) and acute inflammatory demyelinating polyneuropathy (AIDP)(4%). tuberculous meningitis (TBM) was the most common presentation as secondary CNS illness (34%), followed by cryptococcal meningitis (14%), toxoplasmosis (10%), progressive multifocal leucoencephalopathy (PML) (8%) and neurosyphilis (4%). Meningitis was presenting CNS manifestation in majority of patients. The commonest presentation of TBM was fever (64%), while headache for cryptococcal meningitis (71%) and seizures was that of toxoplasmosis (80%). Mean CD 4 count was 170 ± 80.1 in patients of DSPN, 131 ± 85.75 for TBM, 47.5 ± 36.8 for cryptococcal, 160 ± 77.4 for toxoplasmosis and 93 ± 65 for ADC. Conclusion: High degree of clinical suspicion of nervous involvement in HIV patients at all stages help in early diagnosis and institution of specific therapeutic measures which in turn decrease mortality and morbidity.
Curēus, 2024
Idiopathic intracranial hypertension (IIH) or benign intracranial hypertension affects the neuroophthalmological system and leads to elevated intracranial pressure. Elevated opening pressure during lumbar puncture is diagnostic of IIH. Here in, we present an interesting case of a 15-year-old girl, recently immigrated and with a high BMI, presenting with recurrent fever, abdominal issues, weight loss, and other symptoms, leading to a diagnosis of pelvic inflammatory disease (PID) and HIV infection. After treatment with antibiotics (doxycycline) and antiretroviral therapy, she developed IIH, manifesting as sudden-onset headache and vision problems. MRI and lumbar puncture confirmed the diagnosis. She responded well to acetazolamide and was discharged with continued medication and follow-up appointments. This case underscores the complexity of IIH development, especially in the setting of acute HIV infection and antibiotic treatment, highlighting the need for a comprehensive diagnostic approach and multidisciplinary management.
Clinico-epidemiological profile of central nervous system manifestations in HIV patients
Introduction: The neurologic complications of HIV infection are both common and diverse. The neurologic abnormalities in HIV infected individuals can be due either to opportunistic infections, neoplasm or to direct effects of HIV or its products. This research aims to study the frequency and clinical profile of neurologic disorders in HIV/AIDS and to study various infectious and non-infectious neurologic disorders in HIV/AIDS. Methodology: We designed a cross-sectional study of all patients who were diagnosed with HIV were investigated to know about the neurological manifestations. Results: During the study period we enrolled 108 HIV positive patients. Tubercular (TB) meningitis, cryptococcal meningitis, toxoplasmosis, tuberculoma, primary central nervous system (CNS) lymphoma and progressive multifocal leukoencephalopathy (PML) and peripheral neuropathy were the neurological manifestations seen. Conclusions: Dysfunction of practically all segments of the nervous system is seen as a...
DIFFERENTIAL DIAGNOSIS OF HIV POSITIVE PATIENTS WITH NEUROLOGICAL MANIFESTATIONS
National Journal of Medical Research, 2017
Introduction: The nervous system is among the most frequent and serious target of HIV infection and is most frequently occur in patient with profound immunosuppression. 40 to 70 percent persons with HIV have neurological disorder. In 10 to 20 percent it is AIDS defining illness. It has higher mortality than other infections. Considering these facts the current study was designed to check the differential diagnosis of various neurological manifestations in HIV patients. Methodology: All HIV positive patients above 18 years presenting with neurological manifestations and ready to give informed written consent to participate in the study were included in the study. Detailed clinical history with special emphasis on consciousness, convulsions and headache was taken. Thorough clinical examination included mental status examination including MMSE, sensory, motor and cranial nerves examination. Results: The present study comprises 50 HIV infected patients with neurological manifestation presenting at the hospital. There were total 15 (30%) patients diagnosed with primary neurological illness. Most of the patients were having DSPN as primary neurological illness. ADC is one of the common neurological manifestations. 4% of our patients had ADC which is diagnosed by MMSE (mini mental status examination) score. Out of total 50 patients, 35 (60%) patients were diagnosed as Secondary Neurological Illness. Out of these, TBM was the most common illness, Other common secondary illnesses were Cryptococcal Meningitis (16%), Toxoplasmosis (10%) and PML (8%). Conclusion: Tubercular Meningitis and Distal sensory polyneuropathy were the most common cause of neurological manifestation among HIV positive patients.
Clinical profile of neurological manifestation in Human Immunodeficiency Virus-positive patients
North American Journal of Medical Sciences, 2012
Human Immunodeficiency Virus (HIV) infection is a global pandemic. According to the data released by UNAIDS in 2007, India had 2.5 million people living with HIV infection. [1] Next to sub-Saharan Africa, it has the second largest burden of HIV-related illness. Though the main targets of HIV infection are the cells of the immune system, the nervous system is often damaged during the course of infection, not only by disease processes that are secondary to immune dysfunction but also by more fundamental effects of the retrovirus. Neurological disease is the first manifestation of symptomatic HIV infection in roughly 10-20% of patients, while about 60% of patients with advanced HIV disease will have clinically evident neurological dysfunction. [2-4] Autopsy studies of patients with advanced HIV disease have demonstrated pathologic abnormalities of the nervous system in 75-90% of cases, [2,5,6] thus proving that the incidence of subclinical neurological disease is even higher. This may be explained by the fact that the central nervous system (CNS) is a sanctuary site for HIV infection and there is poor CNS penetration of antiviral drugs due to the presence of intact blood brain barrier. [2] We undertook this study to see the prevalence of the various neurological manifestations in HIV-positive admitted patients who presented to a tertiary hospital in our setup.
Asian Journal of Pharmaceutical and Clinical Research, 2020
Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center. Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system. Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm 3 and in females are 229.57/mm 3 whereas the mean absolute leukocyte count in males is 1088.30/mm 3 and in females is 1473.52/mm 3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count. Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm 3. Neurological complications did not show any correlation with the patient being on antiretroviral therapy.