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cerebral cortex, with little recognizable neuronal loss In other patients, small or large perivascular foci of demyelination, like those of postinfectious encephalomyelitis, are observed; the nature of this diffuse lesion is not understood These forms of pathologic change may occur singly or together and all correlate poorly with the severity of the dementia AIDS Myelopathy, Peripheral Neuropathy, and Myopathy A myelopathy, taking the form of a vacuolar degeneration that bears a striking resemblance to subacute combined degeneration due to vitamin B12 de ciency, is sometimes associated with the AIDS dementia complex; or the myelopathy may occur in isolation, as the leading manifestation of the disease (Petito et al) This disorder of the spinal cord is discussed further on page 1059 AIDS may also be complicated by several forms of peripheral neuropathy Of 50 such patients reported by Snider and coworkers, 8 had a distal, symmetrical, axonal polyneuropathy, predominantly sensory and dysesthetic in type This has been the most common neuropathic pattern The HIV virus has been isolated from the peripheral nerves and ganglia In fact, this stands as the rst proven viral polyneuritis in man (Zoster being more a ganglionopathy) In other patients, a painful mononeuropathy multiplex occurs, seemingly related to a focal vasculitis, or there may be a subacute in ammatory cauda equina syndrome (a polyradiculitis) that is usually due to an accompanying CMV infection (Eidelberg et al) Cornblath and colleagues have documented the occurrence of an in ammatory demyelinating peripheral neuropathy, of both the acute (Guillain-Barre) and chronic types, in otherwise asympto matic patients with HIV infection Most of these patients had a mild pleocytosis in addition to an elevated CSF protein content Also, all of the patients with in ammatory demyelinating neuropathy recovered either spontaneously or in response to plasma exchange suggesting an immunopathogenesis similar to that of the Guillain-Barre syndrome Cornblath and associates have suggested that all patients with in ammatory demyelinating polyneuropathies should now be tested for the presence of HIV infection, but this is probably appropriate only in groups of patients or in geographic areas where the disease is prevalent Facial palsy is being reported with increasing frequency as a feature of AIDS; its relationship to the generalized polyneuritis of AIDS is uncertain In the rare complication of AIDS called diffuse in ltrative lymphocytosis syndrome (DILS), a variety of clinical syndromes has been described, including all of the usual AIDS polyneuropathies Some instances of polyneuropathy in AIDS patients are probably due to the nutritional depletion that characterizes advanced stages of the disease and to the effects of therapeutic agents These AIDS-related neuropathies are discussed in Chap 46 and are well summarized by Wulff and Simpson A primary myopathy, taking the form of an in ammatory polymyositis, has been described in AIDS patients, occurring at any stage of the disease (Simpson and Bender) In some of these cases, the myopathy has improved with corticosteroid therapy The original anti-AIDS drug, zidovudine (AZT), has been said to cause a myopathy, probably due to its effect on mitochondria, but some workers disagree and nd almost all such cases to be attributable to the AIDS virus itself (see page 1203) From listening to the discussions of our colleagues, it is apparent that this remains an area of controversy Opportunistic Infections and Neoplasms of the CNS in AIDS In addition to the direct neurologic effects of HIV infection, a va-. asp.net upc-a UPC-A . NET Control - UPC-A barcode generator with free . NET ...
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