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pdfmake, client/server side PDF printing in pure JavaScript. niques cannot distinguish these two diseases with certainty, lymphoma more often is solitary Other less common lesions should be suspected if there is preceding bacteremia, positive tuberculin test, fungemia, or injection drug use These include bacterial abscesses, cryptococcomas, tuberculomas, and Nocardia lesions Because techniques for stereotactic brain biopsy have improved, this procedure plays an increasing role in diagnosing cerebral lesions Biopsy should be strongly considered if lesions are solitary or do not respond to toxoplasmosis treatment, especially if they are easily accessible Diagnosis of lymphoma is important because many patients benefit from treatment (radiation therapy) In the future, it may be possible to avoid brain biopsy by utilizing polymerase chain reaction (PCR) assay of cerebrospinal fluid for Epstein Barr virus DNA, which is present in 90% of CNS lymphoma cases c AIDS dementia complex The diagnosis of AIDS dementia complex (HIV-associated cognitive-motor complex) is one of exclusion based on a brain imaging study and on spinal fluid analysis that excludes other pathogens Neuropsychiatric testing is helpful in distinguishing patients with dementia from those with depression Patients with AIDS dementia complex typically have difficulty with cognitive tasks and exhibit diminished motor speed Patients may first notice a deterioration in their handwriting The manifestations of dementia may wax and wane, with persons exhibiting periods of lucidity and confusion over the course of a day Many patients improve with effective antiretroviral treatment Metabolic abnormalities may also cause changes in mental status: hypoglycemia, hyponatremia, hypoxia, and drug overdose are important considerations in this population Other less common infectious causes of encephalopathy include progressive multifocal leukoencephalopathy (discussed below), CMV, syphilis, and herpes simplex encephalitis d Cryptococcal meningitis Cryptococcal meningitis typically presents with fever and headache Less than 20% of patients have meningismus Diagnosis is based on a positive latex agglutination test that detects cryptococcal antigen (or CRAG ) or positive culture of spinal fluid for Cryptococcus Seventy to 90% of patients with cryptococcal meningitis have a positive serum CRAG Thus, a negative serum CRAG test makes a diagnosis of cryptococcal meningitis unlikely and can be useful in the initial evaluation of a patient with headache, fever, and normal mental status HIV meningitis, characterized by lymphocytic pleocytosis of the spinal fluid with negative culture, is common early in HIV infection e HIV myelopathy Spinal cord function may also be impaired in HIV-infected individuals HIV myelopathy presents with leg weakness and incontinence Spastic paraparesis and sensory ataxia are seen on neurologic examination Myelopathy is usually a late manifestation of HIV disease, and most patients will have concomitant HIV encephalopathy Pathologic evaluation of the spinal cord reveals vacuolation of white matter Because HIV myelopathy is a diagnosis of exclusion, symptoms suggestive of myelopathy should be evaluated by lumbar puncture to rule out CMV polyradiculopathy (described below) and an MRI or CT scan to exclude epidural lymphoma. javascript pdf generator client side: jsPDF - HTML5 PDF Generator | Parallax javascript pdf generator library Convert HTML/CSS Content to a Sleek Multiple Page PDF File ...
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pdfmake, client/server side PDF printing in pure JavaScript. f Progressive multifocal leukoencephalopathy (PML) PML is a viral infection of the white matter of the brain seen in patients with very advanced HIV infection It typically results in focal neurologic deficits such as aphasia, hemiparesis, and cortical blindness Imaging studies are strongly suggestive of the diagnosis if they show nonenhancing white matter lesions without mass effect Extensive lesions may be difficult to differentiate from the changes caused by HIV Several patients have stabilized or improved after the institution of combination antiretroviral therapy or cidofovir 4 Peripheral nervous system Peripheral nervous system syndromes include inflammatory polyneuropathies, sensory neuropathies, and mononeuropathies An inflammatory demyelinating polyneuropathy similar to Guillain-Barr syndrome occurs in HIV-infected patients, usually prior to frank immunodeficiency The syndrome in many cases improves with plasmapheresis, supporting an autoimmune basis of the disease CMV can cause an ascending polyradiculopathy characterized by lower extremity weakness and a neutrophilic pleocytosis on spinal fluid analysis with a negative bacterial culture Transverse myelitis can be seen with herpes zoster or CMV Peripheral neuropathy is common among HIV-infected persons Patients typically complain of numbness, tingling, and pain in the lower extremities Symptoms are disproportionate to findings on gross sensory and motor evaluation Beyond HIV infection itself, the most common cause is prior antiretroviral therapy with stavudine or didanosine Patients who report these symptoms should be switched to an alternative agent if possible Caution should be used when administering these agents to patients with a history of peripheral neuropathy Unfortunately, drug-induced neuropathy is not always reversed when the offending agent is discontinued Patients with advanced disease may also develop peripheral neuropathy even if they have never taken antiretroviral therapy Evaluation should rule out other causes of sensory neuropathy such as alcoholism, thyroid disease, vitamin B12 deficiency, and syphilis Treatment of peripheral neuropathy is aimed at symptomatic relief Patients should be initially treated with gabapentin (start at 300 mg at bedtime and increase to 300 900 mg orally three times a day) Although many clinicians initiate a trial of amitriptyline (10 25 mg orally at bedtime), responses to this agent are uncommon 5 Rheumatologic manifestations Arthritis, involving single or multiple joints, with or without effusion, has been commonly noted in HIV-infected patients Involvement of large joints is most common Although the cause of HIVrelated arthritis is unknown, most patients will respond to nonsteroidal anti-inflammatory drugs Patients with a sizable effusion, especially if the joint is warm or erythematous, should have the joint tapped, followed by culture of the fluid to rule out suppurative arthritis as well as fungal and mycobacterial disease Several rheumatologic syndromes, including reactive arthritis (Reiter s syndrome), psoriatic arthritis, sicca syndrome, and systemic lupus erythematosus, have been reported in HIV-infected patients (see 20) However,. javascript pdf creation library PDFMake
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