tailieunhanh - Tropical Neurology - part 5

Các nguyên nhân của multiplex mononeuropathy vào cuối HIV có thể là do nhiễm trùng như herpes zoster, Cryptococcus, toxoplasma và cytomegalovirus; và neoplastics như u lympho và cryoglobulinaemia. Điều trị mononeuropathy multiplex trong HIV giai đoạn cuối bao gồm điều trị AR | Neurological Manifestations of HIV 209 Fig. . Radiography of chest showing multiple lung abscesses in a 60 year old lady with AIDS Courtesy Prof. U. K. Misra . in two or more limbs or multiple cranial nerves as opposed to limited involvement in the early stage. The etiology of mononeuropathy multiplex in late HIV may be due to infections such as herpes zoster cryptococcus toxoplasma and cytomegalovirus and neoplastics such as lymphoma and cryoglobulinaemia. Treatment of mononeuropathy multiplex in late stage HIV includes antiretroviral therapy and treatment of underlying infection. If no cause can be detected empirical treatment with gancyclovir is recommended. Progressive polyradiculopathy occurs late in the course of HIV disease and a large number of patients have coexisting cytomegalovirus CMV infection however with effective antiretroviral therapy the incidence of CMV-induced polyradiculopathy has declined. Patients present with radiating pain and paresthesias in cauda equina distribution resulting in cauda equina syndrome. Radiculopathy in upper limbs occurs in the late stage of disease. It has a poor prognosis with nearly 100 mortality within 30 days. Cerebrospinal fluid reveals raised protein and lymphocytic pleocytosis. PCR may be positive for CMV DNA. Myelography and MRI demonstrate enhancement of lumbar thecal sac or leptomeninges in conus medullaris to cauda equina. Gancyclovir with other antiretroviral drugs is used for its treat 12 ment. 210 Tropical Neurology 12 Fig. . Gadolinium enhanced spinal MRI Ti sequence in sagittal section of the same patient as in Figure showing cervical vertebral involvement with prevertebral soft tissue shadow due to tuberculosis Courtesy Prof. U. K. Misra . Neurological Manifestations of HIV 211 Autonomic neuropathy seems to occur in late HIV disease particularly when other neurologic deficits are present. Drugs such as tricyclic antidepressant vincristine and pentamidine may contribute to autonomic .