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Author25 Posts
  #1

A 35 yr old HIV positive man comes to the 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 in hand writing.Neurological exam show deficit in congnitive and fine motor control functions.Lab investigations show a CD 4 count of 25/mm3.MRI show moderate brain atrophy but no focal lesions A lumbar puncture show 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.PML

G.toxoplasmosis/




  #2

D


  #3

A?


  #4

d?


  #5

can u please also explain why is one option and not the others so we can discuss the case bettersmiling face


  #6

HIV is one of my weaknesses that i will work on it so i have no clue smiling face

i just tried to pick an answer and probably wrongconfused


  #7

Guys...before anyone gets too excited let me tell you that we don't have an anwser to ths q. Sorry...

This q was discussed on the board previously.


  #8

I heard that the usmle q writers are told the questions should be written in such a way that when ppl read it , even without looking at the choices they can guess the answer. Its just so irritating when the q r soo vague and The USMLE expects fresh grads to have done "triple fellowships" on that topicmad

Im sorry I just had to rantshaking head
I wish someone made a microchip of harrison and I cud impant it in my braingrin, the night b4 the teststicking out tongue
only if wishes came truesmiling face
back to studyingnod


  #9

nitts2009 wrote:
I heard that the usmle q writers are told the questions should be written in such a way that when ppl read it , even without looking at the choices they can guess the answer. Its just so irritating when the q r soo vague and The USMLE expects fresh grads to have done "triple fellowships" on that topicmad

Im sorry I just had to rantshaking head
I wish someone made a microchip of harrison and I cud impant it in my braingrin, the night b4 the teststicking out tongue
only if wishes came truesmiling face
back to studyingnod


even if u implant a harrison or cecil microchip u will do some questions wrong hehe

this is the way it supposed to be smiling face


  #10

yep, i've learnt to deal with that
BUT a chip would be SWEETgrin


  #11

ok lets see if i can talk a little bit about each choice...correct me if i am wrong u guys/ geniuses.

A) CMV encephalitis - there should be confusion and problems with CSF. however, our case doesn't show it. (ie. elevated protein and stuff)

B.cryptococcal meningoencephalitis

C.HIV encephalitis - CSF will show elevated protein and erythrocytes.
E.primary brain lymphoma - will show up on CT as ring enhancing, hence will def. be picked up on MRI
G.toxoplasmosis - will be picked up on a MRI as space occupying lesion or something.

Now i am confused between:
F.PML - demyelinating disease (if i had to guess i would go with this one)
& D. HIV myelopathy. (i don't even know what this one is)



  #12

oh crap..i didn't talk about cryptococcal meningioencephalitis..we wouldn't this give fever and abnormal CSF with meningeal irritation signs.


  #13

hard one... i would guess C and would be wrong


  #14

I would go with A,
reason I chose A:
1) im totally clueless
2) Cd4 is 25


  #15

D its HIV myelopathy everything else can be detected on CSF analysis and is the only one mainly associated with loss of bladder control

http://www.aids.org/atn/a-344-03.html


  #16

I think Its D too!


  #17

I think the answer is C.

I've just read whole part of HIV complication in CMDT.
C HIV encephalopathy= AIDS dementia complex, i think.
pt's Sx is a kind of cognitive impairment not a spinal dysfunction. so D is wrong choice.

Just read the HIV part regarding AIDS dementia complex.


  #18

D


  #19

I'll post the part of CMDT.

c. AIDS dementia complex —

The diagnosis of AIDS dementia complex (HIV-associated cognitive-motor complex) is one of exclusion based on a brain imaging study and on spinal fluid analysis that excludes other pathogens. Neuropsychiatric testing is helpful in distinguishing patients with dementia from those with depression. Patients with AIDS dementia complex typically have difficulty with cognitive tasks and exhibit diminished motor speed. Patients may first notice a deterioration in their handwriting. The manifestations of dementia may wax and wane, with persons exhibiting periods of lucidity and confusion over the course of a day. Many patients improve with effective antiretroviral treatment. Metabolic abnormalities may also cause changes in mental status: hypoglycemia, hyponatremia, hypoxia, and drug overdose are important considerations in this population. Other less common infectious causes of encephalopathy include progressive multifocal leukoencephalopathy (discussed below), cytomegalovirus, syphilis, and herpes simplex encephalitis.

e. HIV myelopathy —

Spinal cord function may also be impaired in HIV-infected individuals. HIV myelopathy presents with leg weakness and incontinence. Spastic paraparesis and sensory ataxia are seen on neurologic examination. Myelopathy is usually a late manifestation of HIV disease, and most patients will have concomitant HIV encephalopathy. Pathologic evaluation of the spinal cord reveals vacuolation of white matter. Because HIV myelopathy is a diagnosis of exclusion, symptoms suggestive of myelopathy should be evaluated by lumbar puncture to rule out cytomegalovirus polyradiculopathy (described below) and an MRI or CT scan to exclude epidural lymphoma.



  #20

PML





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