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title:Differential Diagnosis of HIV Positive Patients with Neurological Manifestations

Author:Ankur S Patel, HemantKumar M Shah, Ashok K Gagia, Dipika A Patel, Vinod A Dandge, Komal V Gamit, Nirmal K Patel

Keywords:HIV, Distal sensory polyneuropathy, TB Meningitis, AIDS dementia complex, Cryptococcal Meningitis

Type:Original Article

Abstract:Introduction: The nervous system is among the most frequent and serious target of HIV infection and is most frequently occur in patient with profound immunosuppression. 40 to 70 percent persons with HIV have neurological disorder. In 10 to 20 percent it is AIDS defining illness. It has higher mortality than other infections. Considering these facts the current study was designed to check the differential diagnosis of various neurological manifestations in HIV patients. Methodology: All HIV positive patients above 18 years presenting with neurological manifestations and ready to give informed written consent to participate in the study were included in the study. Detailed clinical history with special emphasis on consciousness, convulsions and headache was taken. Thorough clinical examination included mental status examination including MMSE, sensory, motor and cranial nerves examination. Results: The present study comprises 50 HIV infected patients with neurological manifestation presenting at the hospital. There were total 15 (30%) patients diagnosed with primary neurological illness. Most of the patients were having DSPN as primary neurological illness. ADC is one of the common neurological manifestations. 4% of our patients had ADC which is diagnosed by MMSE (mini mental status examination) score. Out of total 50 patients, 35 (60%) patients were diagnosed as Secondary Neurological Illness. Out of these, TBM was the most common illness, Other common secondary illnesses were Cryptococcal Meningitis (16%), Toxoplasmosis (10%) and PML (8%). Conclusion: Tubercular Meningitis and Distal sensory polyneuropathy were the most common cause of neurological manifestation among HIV positive patients.

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