Neurology · MU Sofia

52. Retroviral diseases of the nervous system

Covers neurological disorders caused mainly by HIV and, less commonly, HTLV-1, explaining how each virus affects the CNS, peripheral nerves, spinal cord and muscles, directly or through opportunistic infections. It then walks through HIV-associated syndromes from acute infection to neurocognitive disorder and encephalopathy, opportunistic CNS infections, peripheral neuropathy and myopathy, and HTLV-1 myelopathy. Examination findings, diagnostic tests, differential diagnoses and treatment close the note, and a picture is included.

Inside: 1 section · 1 labelled picture · 14 flashcards · 2 min

Topic 52 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 288 words (2 min of reading), with 14 flashcards.

In this note

  1. Retroviral disease of nervous system

Retroviral disease of nervous system

Definition: Retroviral diseases of the nervous system are neurological disorders caused mainly by Human Immunodeficiency Virus Infection and, less commonly, Human T-lymphotropic virus type 1. These viruses affect the CNS, peripheral nerves, spinal cord, and muscles either directly or through opportunistic infections.

Etiology

A. HIV (most important)

  • Causes: Direct CNS damage. Immunodeficiency → opportunistic infections. Secondary tumors

B. HTLV-1

  • Associated with: Tropical spastic paraparesis. HTLV-1–associated myelopathy (HAM/TSP)

HIV-Associated Neurological Disorders

A. Acute HIV Infection

  • May present as: Aseptic meningitis. Encephalitis. Cranial neuropathies

B. HIV-Associated Neurocognitive Disorder (HAND)

  • Clinical Features: Memory impairment. Poor concentration. Slowed thinking. Behavioral changes. Dementia (advanced disease)

C. HIV Encephalopathy (AIDS Dementia Complex)

  • Features: Progressive cognitive decline. Motor slowing. Gait disturbance. Apathy

Opportunistic CNS Infections in HIV

  • Common infections: Toxoplasmosis. Cryptococcal Meningitis. Progressive Multifocal. Leukoencephalopathy. Tuberculosis. CMV encephalitis

Peripheral Nervous System Involvement

  • Distal Symmetric Polyneuropathy (most common): Burning feet. Numbness. Paresthesia. Reduced ankle reflexes
  • Other Neuropathies: Mononeuropathies. Cranial neuropathies. Inflammatory demyelinating neuropathies

Myopathy

  • HIV may cause: Proximal muscle weakness. Muscle wasting. Elevated CK

HTLV-1–Associated Myelopathy (HAM/TSP)

  • Clinical Features: Slowly progressive spastic paraparesis. Hyperreflexia. Babinski sign. Bladder dysfunction. Mild sensory symptoms
  • Characteristics: Chronic spinal cord disease. Mainly affects corticospinal tracts

Examination Findings

CNS: Cognitive impairment.Dementia. Focal deficits (opportunistic infections).

Spinal Cord: Spastic paraparesis. Hyperreflexia

Peripheral Nerves: Distal sensory loss. Reduced reflexes

Diagnosis

  • HIV: HIV serology. Viral load. CD4 count
  • CSF: Usually lymphocytic changes in CNS infections. Pathogen-specific tests when indicated
  • MRI: White matter lesions. Opportunistic infection patterns. Cerebral atrophy

Differential Diagnosis

  1. 1. Multiple Sclerosis: Demyelinating disease. Different laboratory findings
  2. 2. Alzheimer's Disease: No immunodeficiency. Slower progression
  3. 3. Other Polyneuropathies: Diabetes. Alcohol-related neuropathy
  4. 4. Spinal Cord Compression: Structural lesion on imaging

Treatment

  • HIV: Antiretroviral therapy (ART).
  • Opportunistic infections: Specific antimicrobial treatment
  • Symptomatic treatment: Neuropathic pain control. Rehabilitation

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