CMV neurologic disease: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 2: | Line 2: | ||
==Clinical Features== | ==Clinical Features== | ||
*Typically presents in immunocompromised hosts (e.g. [[AIDS]]) with history of prior CMV illness (e.g. [[CMV retinitis]] | |||
*Usually [[encephalitis]], presenting as a acute, rapid onset, progressive [[encephalopathy]] but can also manifest as polyradiculitis | |||
*Encephalitis: | |||
**Memory impairment with [[dementia]]-like presentation | |||
**[[weakness|Motor deficits]], [[numbness]], [[cranial nerve palsies]] | |||
**[[Ataxia]], [[nystagmus]] | |||
**[[intracranial mass|Mass lesion]] with focal deficits or evidence of mass effect | |||
**+/- [[Fever]] | |||
*Polyradiculitis | |||
**[[Back pain]]/sciatica | |||
**[[Paresthesia]], distal [[numbness|sensory loss]] | |||
**[[Urinary retention]] | |||
**Ascending [[weakness|paralysis]], similar to [[Guillan-Barre]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AMS and fever DDX}} | |||
{{HIV associated conditions}} | |||
==Evaluation== | ==Evaluation== | ||
*Neuroimaging ([[brain MRI|MRI]] more helpful than [[head CT|CT]]) | |||
*CMV PCR | |||
==Management== | ==Management== | ||
| Line 12: | Line 29: | ||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 00:35, 3 October 2019
Background
Clinical Features
- Typically presents in immunocompromised hosts (e.g. AIDS) with history of prior CMV illness (e.g. CMV retinitis
- Usually encephalitis, presenting as a acute, rapid onset, progressive encephalopathy but can also manifest as polyradiculitis
- Encephalitis:
- Memory impairment with dementia-like presentation
- Motor deficits, numbness, cranial nerve palsies
- Ataxia, nystagmus
- Mass lesion with focal deficits or evidence of mass effect
- +/- Fever
- Polyradiculitis
- Back pain/sciatica
- Paresthesia, distal sensory loss
- Urinary retention
- Ascending paralysis, similar to Guillan-Barre
Differential Diagnosis
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[1]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
Management
Antivirals
- Ganciclovir 5mg/kg IV q12hrs x 21 days then 5mg/kg IV q24hrs +
- Foscarnet 90mg/kg IV q12hrs x 21 days then 90-120mg/kg IV q24hrs
Disposition
- Admit
See Also
External Links
References
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.