Progressive dementia with seizures in an HIV infected lady
Joe James, James Jose
The Pan African Medical Journal. 2017;27:242. doi:10.11604/pamj.2017.27.242.9391

Create an account  |  Sign in
Healthcare India 2017 Supplement 2 Supplement
"Better health through knowledge sharing and information dissemination "

Images in medicine

Progressive dementia with seizures in an HIV infected lady

Cite this: The Pan African Medical Journal. 2017;27:242. doi:10.11604/pamj.2017.27.242.9391

Received: 21/03/2016 - Accepted: 20/11/2016 - Published: 02/08/2017

Key words: HIV dementia, HIV, Magnetic Resonance Imaging, computed tomography

© Joe James et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/27/242/full

Corresponding author: Joe James, Department of Internal Medicine, Government Medical College Kozhikode, Kerala, India (drjoejames@gmail.com)


Progressive dementia with seizures in an HIV infected lady

Joe James1,&, James Jose2

 

1Department of Internal Medicine, Government Medical College Kozhikode, Kerala, India, 2Department of Neurology, Government Medical College Kozhikode, Kerala, India

 

 

&Corresponding author
Joe James, Department of Internal Medicine, Government Medical College Kozhikode, Kerala, India

 

 

Image in medicine    Down

A 40-year-old female presented with progressive memory loss over the past 1-month. She had one episode of generalized tonic clonic seizure 2-months back, but did not take any treatment. She had significant involuntary weight loss. On examination she was emaciated and had a BMI of 16.4. Neurological examination showed cognitive decline in the form of loss of recent memory, judgment and abstract thinking, with preserved language and visuospatial orientation. There were no focal neurological deficits. She was tested positive for HIV. Her CD4+ count was 21/L. Computed tomography of the brain revealed bilateral hypodensities in the periventricular area (A). MRI of the brain showed bilateral symmetrical periventricular white matter FLAIR hyperintensities in frontal and parietal lobes with diffuse brain atrophy suggestive of HIV encephalopathy (B). She was started on combination antiretroviral therapy with tenofovir, lamivudine and efavirenz and discharged. HIV encephalopathy refers to neurocognitive disorders associated with HIV infection. It usually occurs in late stages of HIV-infection and correlates with advanced immunosuppression. Earliest recognizable findings include impairment of attention and concentration. This progresses to frank dementia, personality changes and motor abnormalities. Neuroimaging typically shows global cerebral atrophy with symmetrical white matter hyperintensities predominantly in the periventricular area. Lesions of progressive multifocal leukoencephalopathy can mimic HIV encephalopathy, but are usually asymmetric, involve the peripheral U fibres first and have predilection for parieto-occipital lobes. Treatment of HIV encephalopathy is initiation or intensification of anti-retroviral therapy, and psychomotor improvement is usually seen after therapy.

 

Figure 1: A) axial CT showing periventricular hypodensity (arrows); B) MRI Brain FLAIR image highlighting the periventricular lesions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 28 (September - December 2017)

Article tools

This article authors

On Pubmed
On Google Scholar

Navigate this article

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved