achilles
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A 35-year-old HIV-positive man comes to medical attention with a 6-month history of progressive memory loss and incontinence. He is taking zidovudine and a protease inhibitor. He first noticed difficulties with handwriting. Neurologic examination demonstrates deficits in cognitive and fine motor control functions. Laboratory investigations show a CD4 cell count of 25/mm3. MRI studies reveal moderate brain atrophy but no focal lesions. A lumbar puncture shows no CSF abnormalities. Which of the following is the most likely diagnosis?
A. CMV encephalitis
B. Cryptococcal meningoencephalitis
C. HIV encephalitis
D. HIV myelopathy
E. Primary brain lymphoma
F. Progressive multifocal leukoencephalopathy
G. Toxoplasmosis
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| Jinx
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d
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| sachida
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D should be the answer.
Deficiency of all other prodromal and neck regidity rules out encephalitis of all types to me.
Absence of focal symptoms rules out E, F and G
HIV mylopathy is close since patients normaly have a history of slow progression, painless leg weakness, stiffness, sensory loss, imbalance, and sphincter dysfunction. On examination they show spastic pareparesis and hyperreflexia.
On lab studies MRI will show
T2-weighted MRI often shows usually symmetric nonenhancing high-signal areas present on multiple contiguous slices, which may result from extensive vacuolation. This may be confined to the posterior columns, especially the gracile tracts, or may be diffuse.
Other test- Somatosensory evoked potential (SSEP) may be a valuable tool in the diagnosis of AIDS-associated myelopathy, particularly when myelopathy and peripheral neuropathy coexist.
Therapy- only pallaitive once treatable causes are excluded
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| sachida
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Posterior spinal cord at C2-C5 level shows high intensity
Attached Files:
HIV mylopathy.jpg (9 KB, 14 downloads)
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93/91, CS passed, USCE 1 year, PhD (USA), Publications 2, Graduate 1999. Dont need visa
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| mesh
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D
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| drk1980
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how does that explain the cognitive impairment?
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| achilles
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the answer is C-hiv encephalitis.
hiv encephalitis is also known as the AIDS dementia complex and is the most common CNS complication in AIDS pts. it is characterised by cognitive impairment, impairment of motor skills, incontinence and confusion. MRI and CSF studies are useful in excluding other infective and neoplastic diseases.
i went for D myself and got it wrong.
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" it's not whether you get knocked down, it's whether you get up"
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| achilles
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hey cyra, i am not able to add emoticons to my posts and i dont know why. could you pls help me with this. thanks.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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| achilles
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that was quick cyra...i got my smile back thanks 
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| Jinx
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oops!!
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