Original article | Volume 27, Article 242, 02 Aug 2017 | 10.11604/pamj.2017.27.242.9391

Progressive dementia with seizures in an HIV infected lady

Joe James, James Jose

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

Received: 21 Mar 2016 - Accepted: 20 Nov 2016 - Published: 02 Aug 2017

Domain: Clinical medicine

Keywords: HIV dementia, HIV, Magnetic Resonance Imaging, computed tomography

©Joe James et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Joe James et al. Progressive dementia with seizures in an HIV infected lady. Pan African Medical Journal. 2017;27:242. [doi: 10.11604/pamj.2017.27.242.9391]

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

Home | Volume 27 | Article number 242

Original article

Progressive dementia with seizures in an HIV infected lady

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

 

 

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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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original article

Progressive dementia with seizures in an HIV infected lady

Original article

Progressive dementia with seizures in an HIV infected lady

Original article

Progressive dementia with seizures in an HIV infected lady

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HIV dementia

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Progressive dementia with seizures in an HIV infected lady