Neurological syndromes complicating AIDS.

This article presents a preliminary analysis of 118 acquired immunodeficiency syndrome (AIDS) patients with neurologic disease. 86% of patients in this series were homosexual, and the AIDS diagnosis was made on the basis of opportunistic infection in almost 50% and of Kaposi's sarcoma with or without opportunistic infection in 38%. Central nervous system (CNS) infections (e.g., subacute encephalitis, toxoplasmosis, primary CNS lymphoma) were the most common group of complications, and autopsy findings indicated that 87% of patients eventually developed CNS complications. Subacute encephalitis was found alone or with other pathology in over 2/3 of autopsied brains. Principal neuropathologic changes in AIDS include the presence of scattered glial nodules, especially in gray matter. To define the clinical features of the glial nodule subacute encephalitis, the clinical features of 18 patients exhibiting these changes at postmortem examination were further analyzed. With the exception of seizures, clinical manifestations were nonfocal, correlating with the diffuse distribution of the microscopic pathology. CNS symptoms most commonly followed the diagnosis of AIDS by 2-9 months, and 11 of these 18 patients died within 6 months of onset of CNS dysfunction. The electroencephalogram (EEG) was abnormal in 100% of patients tested, while computerized tomographic (CT) scans were abnormal in 70%, with cortical atrophy being the most common finding. The cerebral spinal fluid (CSF) was abnormal in 67%. Early complaints were difficulty in concentration or memory loss which progressed in some to severe global dementia or coma. Neither the etiology nor the pathogenesis of subacute encephalitis have been established, although cytomegalovirus is regarded as a prime etiologic candidate.