The neurological features of HIV-positive patients in Glasgow--a retrospective study of 90 cases

A retrospective study of the neurological problems arising in HIV-I seropositive patients in a single defined geographical area was undertaken. Ninety patients were referred for a neurological opinion from a total known HIV-I seropositive population of 436. Minor problems were frequently encountered early in the course of disease (20 at CDC stage II, 12 at CDC stage III), including seizures related to drug abuse in six. The most frequent neurological problem in those patients in CDC group IV (58 patients) were the AIDS dementia complex (14 patients), an axonal sensorimotor neuropathy (12), toxoplasmosis (nine) and cryptococcal meningitis (three). All patients with a structural lesion had appropriate focal signs on examination. The value and role of CT cranial scanning in the diagnosis of toxoplasmosis is discussed and the importance of recognizing potentially treatable causes of both intellectual impairment and cytomegalovirus-related neuropathies is stressed. This is the first report of an unselected series of patients at all stages of HIV-I related neurological disease from a single UK centre.

Experience with liposomal amphotericin B (AmBisome) in cryptococcal meningitis in AIDS

Three patients with AIDS who had cryptococcal meningitis were treated with liposomal amphotericin B after unsuccessful treatment with fluconazole and conventional amphotericin B. One patient responded but relapsed nine weeks later; he responded to a second course of treatment but again relapsed and subsequently died. Another patient deteriorated despite an improvement in cryptococcal antigen titres. The third patient was found to have culture negative CSF and treatment was therefore stopped. None of the patients suffered any adverse effects and renal function improved in all after conventional amphotericin was stopped and liposomal amphotericin B commenced.

Cryptococcal meningoencephalitis in a patient with Hodgkin's lymphoma: successful treatment with fluconazole

The authors report a case of cryptococcal meningoencephalitis in a 22-year-old male with Hodgkin's disease at third stage B. Cryptococcus neoformans was isolated from cerebral spinal fluid (CSF) and blood specimens. Latex antigen agglutination tests and India ink preparations also were positive for this pathogenic yeast. Drug treatment for a week with 20 mg i.v./day of amphotericin B in combination with 2.5 g i.v./day of 5-fluorocytosine did not lead to any improvement in the patient. The patient became asymptomatic after the first week of treatment with a daily dose of 400 mg of fluconazole, administered intravenously. After two months of this regimen, all laboratory tests on CSF and blood specimens were negative.

Treatment of impaired consciousness with lumbar punctures in a patient with cryptococcal meningitis and AIDS

A 50 year old man with AIDS, cryptococcal meningitis and a normal CT-scan developed impaired consciousness and even deep coma associated with very high CSF pressure. After lumbar CSF drainage consciousness improved dramatically. We conclude that in patients with cryptococcal meningitis who have impaired consciousness and a normal CT scan, CSF drainage to improve the level of consciousness should be considered.