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Home arrow Environment arrow Inflammatory Disorders of the Nervous System: Pathogenesis, Immunology, and Clinical Management
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Other AIDS-Related Neurologic Manifestations

Both ischemic and hemorrhagic strokes have been reported in HIV-infected patients and have been attributed to a relatively elevated incidence of vasculitis and hypercoagulability [16]. Other causes of ischemic strokes in these patients include meningitis, cardioembolism, and hypertension.

Neuro-ophthalmologic disorders of AIDS patients occur in up to 60% of patients with case reports on patients with visual field defects, optic neuropathy, papilledema, ocular motor nerve palsies, and one-and-a-half syndrome [17]. Visual evoked potentials may be abnormal in 57% of patients. Movement disorders have also been described in HIV patients. Patients can develop Parkinsonism at seroconversion or advanced stages. Parkinsonism is also related to HAART treatment and antidopaminergic drugs. Another frequent complaint by HIV patients is sleep disorders, particularly those treated with efavirenz.

Immune Reconstitution Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) is a fascinating syndrome which is recognized by paradoxical worsening of the patient’s clinical and neurological condition once combined antiretroviral therapy (cART) has been initiated.

The pathophysiology of IRIS has been attributed to the recovery of the immune system. IRIS is potentially a dangerous condition. Involvement of the CNS in IRIS is uncommon and may occur in the context of certain opportunistic infections such as tuberculosis, cryptoccocal infection, or PML [18, 19]. It has been hypothesized that IRIS may stem from an aberrant immune response to opportunistic infections. Interestingly, discontinuation of cART is not suggested.

 
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