INFECTIOUS DISEASEHIV ENCEPHALOPATHY(AIDS DEMENTIA)
■ Progressive impairment of memory/cognitive processes caused directly by
HIV
■ Diagnosis of exclusion (work up any progressive signs of AMS).
CRYPTOCOCCUS NEOFORMANS
■ Fungal CNS infection causing focal cerebral lesions or diffuse menin-
goencephalitis
■ Most common with CD4 < 100
SYMPTOMS/EXAM
■ Fever
■ Chronic or subacute headache
■ Nausea/vomiting
■ AMS
■ Focal neuro deficits
■ Meningismus uncommon
DIAGNOSIS
■ Head CT negative
■ Elevated opening pressure (~66% of cases)/lymphocytic pleocytosis
■ India ink stain (~70% sensitive)
■ Fungal Cx (~95% sensitive)
■ CSF cryptococcal antigen (100% sensitive/specific)
■ Serum cryptococcal antigen (95% sensitive)
TREATMENT
■ Normal mental status: fluconazole PO
■ AMS: Amphotericin B IV (±flucytosine)
COMPLICATIONS
■ High intracranial pressure →sudden cerebral herniation
■ Fatal if untreated
■ With treatment, mortality ~6%
TOXOPLASMA GONDII(TOXOPLASMOSIS)
#1 cause of focal intracranial mass in HIV (latent resurgence)
SYMPTOMS/EXAM
■ HA
■ Fever
■ Focal neuro deficits (80%)
■ AMS
■ Seizures
DIFFERENTIAL
■ Lymphoma, cerebral TB, fungi, progressive multifocal leukoencephalopa-
thy (PML), CMV, KS, hemorrhage
Any newalteration of mental
status must be fully worked up
in a patient with HIV including
head CT and lumbar
puncture.