Clinical Guide > Common Complaints > Neurologic

Neurologic Symptoms

January 2011

Chapter Contents


The nervous system may be a site of complications throughout the course of HIV infection, and neurologic complaints are common among HIV-infected individuals. Neurologic symptoms may be caused by many factors, including infections (opportunistic and other), central nervous system (CNS) malignancies, medication toxicities, comorbid conditions (e.g., diabetes, cerebrovascular disease, chronic hepatitis, mental illness), and nervous system injuries related to HIV itself.

The risk of some conditions, such as CNS infection, malignancy, and dementia, increases with advancing immunosuppression, and the CD4 cell count will help to stratify the patient's risk of opportunistic illnesses (see Table 1 in chapter Risk of HIV Progression/Indications for ART. This chapter presents a general approach to neurologic symptoms in HIV-infected patients, with reference to other chapters in this manual for more detailed reading. For information on peripheral neuropathy, see chapter Pain Syndrome and Peripheral Neuropathy; for information on neurocognitive disease, see HIV-Associated Dementia and Other Neurocognitive Disorders.

S: Subjective

The patient, or a friend or family member on his or her behalf, reports new neurologic symptoms such as pain, headache, seizures, altered mental status, or weakness.

Ascertain the following during the history:

Differentiate delirium from dementia. Delirium presents as acute onset of clouded sensorium, disturbed and fluctuating level of consciousness, disorientation, cognitive deficits, and reduced attention, sometimes with hallucinations. Delirium often is caused by medication toxicities, infections, hypoxia, hypoglycemia, electrolyte imbalances, or mass lesions, and it frequently is correctable. Dementia emerges more gradually and is characterized by cognitive impairment and behavioral, motor, and affective changes. See chapter HIV-Associated Dementia and Other Neurocognitive Disorders.

O: Objective

A: Assessment

The differential diagnosis of neurologic abnormalities in patients with HIV infection may be broad, particularly if the CD4 count is low. Both HIV-related and HIV-unrelated causes should be considered; remember that more than one cause of symptoms may be present.

Possible Causes of Neurologic Abnormalities

Causes related to the cerebrum or cranial nerves

Causes related to the spinal cord, nerve roots, peripheral nerves, and muscle

Note that organic causes of neurologic symptoms must be ruled out before concluding that symptoms are psychiatric in nature.

P: Plan

Diagnostic Evaluation

Unstable or seriously ill patients should be hospitalized for evaluation and treatment. Criteria for hospitalization include acutely altered mental status, fever with focal neurologic findings, and new or unstable seizures.

Perform laboratory work and other diagnostic studies as suggested by the history, physical examination, and differential diagnosis. This may include the following:


Specific treatment will depend on the cause of neurologic symptoms. Consult relevant chapters in this manual. For complex cases, consult with an HIV-experienced neurologist.

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