Advertisement

AIDS and the Neurosurgeon — an Update

Chapter
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 21)

Summary

Over the past decade, acquired immunodeficiency syndrome (AIDS) has become the leading public health crisis in the United States, Western Europe, and Africa. Despite improvements in the diagnosis and treatment of AIDS-related disorders, the number of people infected with the human immunodeficiency virus (HIV-1) continues to grow, requiring a greater proportion of limited financial, medical, and human resources. Since nearly one half of symptomatic AIDS patients have neuropathologie disease, clinicians must be aware of the myriad neurologic manifestations of AIDS and use the most effective methods to diagnose and treat them. The work-up of the AIDS patient with neurologic symptoms includes a careful history and physical examination, laboratory studies, and radiographic imagine Gadoliniumenhanced magnetic resonance (MR) imaging has become the radiographic screening study of choice, MR imaging can be used to predict which patients should undergo stereotactic biopsy before an empirical trial of anti-toxoplasmosis therapy. Any patient with a mass lesion that does not respond to empirical therapy for toxopiasmosis should also undergo biopsy to exclude another treatable disorder. While the number of patients wish neurological complications can be expected to increase in the near future, better imaging techniques may obviate the need for biopsy in many of these. patients. The increasing threat of HIV- 1 infection in the workplace requires meticulous care both in and out of the opeiaiing room to minimize accidental exposure of healhe-care workes.

Key words

Acquired immuaordefiency sysdrosie AIDS anurological manifestations diagnosis treatment strategies 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Baumgartner JE, Rachlin JR, Beckstead JH, Meeker TC, Levy RM, Wara WM, Rosenblum ML (1990) Primary central nervous system lymphomas: natural history and response to radiation therapy in 55 patients with acquired immunodeficiency syndrome. J Neurosurg 73: 206–211.PubMedCrossRefGoogle Scholar
  2. 2.
    Bloom DE, Carlinier G (1988) The economic impact of AIDS in the United States. Science 239: 604–609.PubMedCrossRefGoogle Scholar
  3. 3.
    Bozzette SA, Larsen RA, Chiu J, Leal MA, Jacobsen J, Rothman P, Robinson P, Gilbert G, McCutchan JA, Tilles J (1991) A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. N Engl J Med 324: 580–584.PubMedCrossRefGoogle Scholar
  4. 4.
    Bredesen DE, Levy RM, Rosenblum ML (1989) Human immunodeficiency virus-related neurological dysfunction. In: Aminoff MJ (ed) Neurology and general medicine. Churchill Livingstone, New York, pp 673–689.Google Scholar
  5. 5.
    Ciricillo SF, Rosenblum ML (1990) Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 73: 720–724.PubMedCrossRefGoogle Scholar
  6. 6.
    Ciricillo SF, Rosenblum ML (1991) Imaging of solitary lesions in AIDS. J Neurosurg 74: 1029 (Letter).PubMedGoogle Scholar
  7. 7.
    Cohen AJ, Phillips T, Keffler C (1986) Circulating coagulation inhibitors in the acquired immune deficiency syndrome. Ann Intern Med 104: 175–180.PubMedGoogle Scholar
  8. 8.
    Cornblath DR, McArthur JC, Kennedy PG, Witte AS, Griffin JW (1987) Inflammatory demyelinating peripheral neuropathies associated with human T-cell lymphotrophic virus type III infection. Ann Neurol 21: 32–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Craddock C, Pasvol G, Bull R, Protheroe A, Hopkin J (1987) Cardiorespiratory arrest and autonomic neuropathy in AIDS. Lancet 2: 16–18.PubMedCrossRefGoogle Scholar
  10. 10.
    Curran JW, Jaffe HW, Hardy AM, Morgan WM, Selik RM, Dondero TJ (1988) Epidemiology of HIV infection and AIDS in the United States. Science 239: 610–616.PubMedCrossRefGoogle Scholar
  11. 11.
    De La Paz R, Enzmann D (1988) Neuroradiology of acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven, New York, p 121.Google Scholar
  12. 12.
    Eidelberg D, Sotrel A, Vogel H, Walker P, Kleefield J, Crumpacker CS 3rd (1986) Progressive polyradiculopathy in acquired immune deficiency syndrome. Neurology 36: 912–916.PubMedGoogle Scholar
  13. 13.
    Gill PS, Graham RA, Boswell W, Meyer P, Krailo M, Levine AM (1986) A comparison of imaging, clinical, and pathologic aspects of space-occupying lesions within the brain in patients with acquired immune deficiency syndrome. Am J Physiol Imaging 1: 124–141.Google Scholar
  14. 14.
    Hessol NA, Byers RH, Lifson AR, O’Malley PM, Cannon L, Barnhart JL, Harrison JS, Rutherford GW (1990) Relationship between AIDS latency period and AIDS survival time in homosexual and bisexual men. J Acquir Immune Defic Syndr 3: 1078–1085.PubMedGoogle Scholar
  15. 15.
    Ho DD, Rota TR, Schooley RT, Kaplan JC, Allan JD, Groopman JE, Resnick L, Felsenstein D, Andrews CA, Hirsch MS (1985) Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome. N Engl J Med 313: 1493–1497.PubMedCrossRefGoogle Scholar
  16. 16.
    Imagawa DT, Lee MH, Wolinsky SM, Sano K, Morales F, Kwok S, Sninsky JH, Nishanian PG, Giogi J, Fahey JL (1989) Human immunodeficiency virus type 1 infection in homosexual men who remain seronegative for prolonged periods. N Engl J Med 320: 1458–1462.PubMedCrossRefGoogle Scholar
  17. 17.
    Jarvik JG, Hesselink JR, Kennedy C, Teschke R, Wiley C, Spector S, Richman D, McCutchan JA (1988) Acquired immunodeficiency syndrome. Magnetic resonance patterns of brain involvement with pathologic correlation. Arch Neurol 45: 731–736.PubMedCrossRefGoogle Scholar
  18. 18.
    Koppel BS, Wormser GP, Tuchma AJ, Maayan S, Hewlett D Jr, Daras M (1985) Central nervous system involvement in patients with acquired immune deficiency syndrome (AIDS). Acta Neurol Scand 71: 337–351.PubMedCrossRefGoogle Scholar
  19. 19.
    Levy JA (1989) Human immunodeficiency virus and the pathogenesis of AIDS. JAMA 261: 2997–3006.PubMedCrossRefGoogle Scholar
  20. 20.
    Levy RM, Bredesen DE, Rosenblum ML (1985) Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62: 475–495.PubMedCrossRefGoogle Scholar
  21. 21.
    Levy RM, Rosenbloom S, Perrett LV (1986) Neuroradiologic findings in AIDS: a review of 200 cases. AJR 147: 977–983.PubMedGoogle Scholar
  22. 22.
    Lipkin WI, Parry G, Kiprov D, Abrams D (1985) Inflammatory neuropathy in homosexual men with lymphadenopathy. Neurology 35: 1479–1483.PubMedGoogle Scholar
  23. 23.
    Mann J (1992) AIDS. The second decade: a global perspective. J Infect Dis 165: 245–250.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller RF, Semple SJ (1987) Autonomie neuropathy in AIDS. Lancet 2: 343–344 (Letter).PubMedCrossRefGoogle Scholar
  25. 25.
    Miller RG, Kiprov DD, Parry G, Bredesen DE (1988) Peripheral nervous system dysfunction in acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven, New York, pp 65–78.Google Scholar
  26. 26.
    Miller RG, Parry G, Lang W, Lippert R, Kiprov DD (1985) AIDS-related inflammatory polyradiculopathy: prediction of response to plasma exchange with electrophysiologic testing. Muscle Nerve 8: 626.CrossRefGoogle Scholar
  27. 27.
    Mishra BB, Sommers W, Koski CK, Greenstein JI (1985) Acute inflammatory demyelinating polyneuropathy in the acquired immune deficiency syndrome. AnnNeurol 18: 131.Google Scholar
  28. 28.
    Morgan WM, Curran JW (1986) Acquired immunodeficiency syndrome: current and future trends. Public Health Rep 101: 459–465.PubMedGoogle Scholar
  29. 29.
    Moskowitz LB, Hensley GT, Chan JC, Gregorios J, Conley FK (1984) The neuropathology of acquired immune deficiency syndrome. Arch Pathol Lab Med 108: 867–872.PubMedGoogle Scholar
  30. 30.
    Olsen WL, Longo FM, Mills CM, Norman D (1988) White matter disease in AIDS: findings at MR imaging. Radiology 169: 445–448.PubMedGoogle Scholar
  31. 31.
    Piot P, Plummer FA, Mhalu FS, Lamboray J-L, Chin J, Mann JM (1988) AIDS: an international perspective. Science 239: 573–579.PubMedCrossRefGoogle Scholar
  32. 32.
    Post MJD, Sheldon JJ, Hensley GT, Soila K, Tabias JA, Chan JC, Quencer RM, Moskowitz LB (1986) Central nervous system disease in acquired immunodeficiency syndrome: prospective correlation using CT, MR imaging, and pathologic studies. Radiology 158: 141–148.PubMedGoogle Scholar
  33. 33.
    Post MJD, Tate LG, Quencer RM, Hensley GT, Berter JR, Sheremata WA, Maul G (1988) CT, MR, and pathology in HIV encephalitis and meningitis. AJR 151: 373–380.PubMedGoogle Scholar
  34. 34.
    Price RW, Brew B, Sidtis J, Rosenblum M, Scheck AC, Cleary P (1988) The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science 239: 586–592.PubMedCrossRefGoogle Scholar
  35. 35.
    Ramsey RG, Geremia GK (1988) CNS complications of AIDS: CT and MR findings. AJR 141: 448–454.Google Scholar
  36. 36.
    Rosenblum ML, Levy RM, Bredesen DE (1988a) Algorithms for the treatment of AIDS patients with neurological diseases. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven, New York, pp 389–395.Google Scholar
  37. 37.
    Rosenblum ML, Levy RM, Bredesen DE (1988b) Neurosurgical implications of the acquired immunodeficiency syndrome (AIDS). Clin Neurosurg 34: 419–445.PubMedGoogle Scholar
  38. 38.
    Rosenblum ML, Levy RM, Bredesen DE (1988c) Overview of AIDS and the nervous system. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven, New York, pp 1–12.Google Scholar
  39. 39.
    Schiff SJ (1990) A surgeon’s risk of AIDS. J Neurosurg 73: 651–660.PubMedCrossRefGoogle Scholar
  40. 40.
    Snider WD, Simpson DM, Nielson S, Gold JWM, Metroka CE, Posner JB (1983) Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 14: 403–418.PubMedCrossRefGoogle Scholar
  41. 41.
    Taylor JMG (1989) Models for the HIV infection and AIDS epidemic in the United States. Stat Med 8: 45–58.PubMedCrossRefGoogle Scholar
  42. 42.
    Tucker T, Dix RD, Katzen C, Davis RL, Schmidley JW (1985) Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome. Ann Neurol 18: 74–79.PubMedCrossRefGoogle Scholar
  43. 43.
    Wiley JA, Samuel MC (1989) Prevalence of HIV infection in the USA. AIDS 3[Suppl]: S71–S78.PubMedCrossRefGoogle Scholar
  44. 44.
    Yanker BY, Skolnick P, Shoukimas GM, Gabuzda DH, Sobel RA, Ho DD (1986) Cerebral granulomatous angiitis associated with acute HTLV-III infection of the central nervous system. Ann Neurol 20: 362–364.CrossRefGoogle Scholar
  45. 45.
    Yarchoan R, Berg G, Brouwers P, Fischl MA, Spitzer AR, Wickman A, Grafman J, Thomas RV, Safai B, Brunetti A, Perno CF, Schmidt PJ, Larson SM, Myers CE, Broder S (1987) Response of human-immunodeficiencyvirus-associated neurological disease to 3′azido-3′-deoxythymidine. Lancet 1: 132–135.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1994

Authors and Affiliations

  1. 1.Department of Neurological Surgery, School of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Neurological SurgeryHenry Ford Medical CenterDetroitUSA

Personalised recommendations