AIDS dementia
Background
- Also referred to as HIV encephalopathy
- Progressive disorder heralded by impairment of recent memory and other cognitive deficits
- Occurs in 10-15% of HIV+ patients; 30% of patients with CD4 <100
- Diagnosis of exclusion
Clinical Features
- Can initially be confused with depression, anxiety disorders, or substance abuse
- Changes in mental status
- Aphasia
- Motor abnormalities
- Patients with an established diagnosis of AIDS dementia who develop progressive neurologic or psychologic signs or symptoms warrant further evaluation for systemic or CNS processes
Differential Diagnosis
Diffuse brain dysfunction
- Hypoxic encephalopathy
- Acute toxic-metabolic encephalopathy (Delirium)
- Hypoglycemia
- Hyperosmolar state (e.g., hyperglycemia)
- Electrolyte Abnormalities (hypernatremia or hyponatremia, hypercalcemia)
- Organ system failure
- Hepatic Encephalopathy
- Uremia/Renal Failure
- Endocrine (Addison's disease, Cushing syndrome, hypothyroidism, myxedema coma, thyroid storm)
- Hypoxia
- CO2 narcosis
- Hypertensive Encephalopathy
- Toxins
- TTP / Thrombotic thrombocytopenic purpura
- Alcohol withdrawal
- Drug reactions (NMS, Serotonin Syndrome)
- Environmental causes
- Deficiency state
- Wernicke encephalopathy
- Subacute Combined Degeneration of Spinal Cord (B12 deficiency)
- Vitamin D Deficiency
- Zinc Deficiency
- Sepsis
- Osmotic demyelination syndrome (central pontine myelinolysis)
- Limbic encephalitis
Primary CNS disease or trauma
- Direct CNS trauma
- Diffuse axonal injury
- Subdural/epidural hematoma
- Vascular disease
- SAH
- Stroke
- Hemispheric, brainstem
- CNS infections
- Neoplasms
- Paraneoplastic Limbic encephalitis
- Malignant Meningitis
- Pancreatic Insulinoma
- Seizures
- Nonconvulsive status epilepticus
- Postictal state
- Dementia
- Alzheimer's
- Lewy Body Dementia
- Frontotemporal Dementia
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Pneumocystis jirovecii pneumonia (PCP)
- Tuberculosis (TB)
- CMV pneumonia
- Ophthalmologic complications
- Other
- HAART medication side effects[1]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- Evaluate for alternate/reversible causes of symptoms
- Head CT shows cortical atrophy and ventricular enlargement
- Associated with elevated CSF protein in 50-70% of cases
Management
- HAART
- Supportive care
See Also
- HIV - AIDS (Main)
- Altered Mental Status
References
- Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.