HIV, Fetal Alcohol and Drug Effects, and the Battered Child
Pediatric AIDS and HIV Infection
Incidence of neurologic abnormalities in HIV-infected cohorts has dropped from around 30% to <2% with antiretroviral drugs. Progressive neurologic dysfunction first evidence of progression to AIDS in 10% of infected children.
HIV Encephalopathy in Children
Progressive or static. Progressive encephalopathy: loss of developmental milestones, progressive pyramidal tract dysfunction, acquired microcephaly or impaired brain growth. Fulminant, progressive, or stepwise. Static encephalopathy less well defined. Imaging may reveal atrophy, foci of demyelination.
Focal Manifestations
Rare in HIV encephalopathy. Focal signs, seizures raise possibility of neoplasm, strokes, opportunistic infection.
Primary CNS lymphoma: most common cause of focal cerebral signs in HIV-infected children (3% to 4% of cases). Seizures in 33% of patients. Differentiation from toxoplasmic brain abscess may require brain biopsy.
Stroke: risk increased with HIV infection (1.3% per year in HIV-infected children). About 50% of strokes hemorrhagic. Nonhemorrhagic stroke, subarachnoid hemorrhage attributed to arteriopathy of large vessels or meninges. Vasculopathy presumed infectious (HIV, varicella zoster virus [VZV]); check VZV PCR in CSF; treat with appropriate antiviral medications. Steroids not indicated, may worsen vasculopathy.Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
