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HIV related Myelopathy

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81. Somatosensory Evoked Potentials: Clinical Applications (Overview)

in the course of the disease, when distal conduction and F-wave studies may be normal Chronic acquired demyelinating neuropathies Infectious causes (eg, HIV) Toxic neuropathies Focal neuropathy The test of choice in focal neuropathy is standard NCSs. Entrapment neuropathies, such as carpal tunnel syndrome, may be found incidentally when SEPs are recorded. The use of SEP for detection of saphenous neuropathy, intercostal neuropathy, and trigeminal neuropathy has been reported. However, standard NCSs (...) fusion and found SSEP to be a highly sensitive and specific test. Data also showed that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits. [ ] Conditions for which SEPs might be useful See the list below: Subacute combined degeneration and myelopathy , to evaluate the effect of spinal cord compression Hereditary spastic paraplegia Transverse myelitis - Lower-limb SEPs produce a higher yield

2014 eMedicine.com

82. Intravenous Immunoglobulin (Overview)

antibodies; natural antibodies can frequently bind to different antigens. [ ] Natural autoantibodies can (1) bind to pathogens; (2) help remove senescent or altered molecules, cells, and tumors; (3) induce remyelination; and (4) inhibit the growth of autoreactive B-cell clones. In the multifocal motor neuropathy disease state, IVIG intercedes to stop complement deposition that is triggered by anti-GM1 antibodies. [ ] The effect of IVIG could also relate to the presence of natural antibodies. IVIG also (...) , corticosteroid-resistant extensive, GCSF-induced Sweet syndrome. [ ] Miscellaneous Adrenoleukodystrophy Acute cardiomyopathy Congenital heart block Autoimmune blistering dermatosis Acute idiopathic dysautonomia Endotoxemia Hemophagocytic syndrome Lower motor neuron syndrome Human T-cell lymphotrophic virus-1–associated myelopathy Nephritic syndrome Membranous nephropathy Euthyroid ophthalmopathy Opsoclonus-myoclonus Recurrent Paraneoplastic cerebellar degeneration Paraproteinemic neuropathy (general

2014 eMedicine.com

83. Human T-Cell Lymphotrophic Viruses (Overview)

, HTLV-II, and HIV in injecting drug users in Salvador, Brazil. J Acquir Immune Defic Syndr Hum Retrovirol . 1998 Jun 1. 18(2):186-7. . Aye MM, Matsuoka E, Moritoyo T, et al. Histopathological analysis of four autopsy cases of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol . 2000 Sep. 100(3):245-52. . Beilke MA, Japa S, Moeller-Hadi C, Martin-Schild S. Tropical spastic paraparesis/human T (...) leukemia virus type 1-associated myelopathy in HIV type 1-coinfected patients. Clin Infect Dis . 2005 Sep 15. 41(6):e57-63. . Berger JR, Svenningsson A, Raffanti S, Resnick L. Tropical spastic paraparesis-like illness occurring in a patient dually infected with HIV-1 and HTLV-II. Neurology . 1991 Jan. 41(1):85-7. . Borg A, Yin JA, Johnson PR, Tosswill J, Saunders M, Morris D. Successful treatment of HTLV-1-associated acute adult T-cell leukaemia lymphoma by allogeneic bone marrow transplantation. Br J

2014 eMedicine.com

84. Vitamin B-12 Associated Neurological Diseases (Overview)

Geriatr Soc . 2003 Mar. 51(3 Suppl):S2-9. . Beach RS, Mantero-Atienza E, Shor-Posner G. Specific nutrient abnormalities in asymptomatic HIV-1 infection. AIDS . 1992 Jul. 6(7):701-8. . Berger JR, Quencer R. Reversible myelopathy with pernicious anemia: clinical/MR correlation. Neurology . 1991 Jun. 41(6):947-8. . Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force (...) . Subacute combined sclerosis of the spinal cord and its relation to anemia and to toxemia. J Nerv Ment Dis . 1899. 26:1. Diaz-Arrastia R. Homocysteine and neurologic disease. Arch Neurol . 2000 Oct. 57(10):1422-7. . Ehrenpreis ED, Carlson SJ, Boorstein HL. Malabsorption and deficiency of vitamin B12 in HIV-infected patients with chronic diarrhea. Dig Dis Sci . 1994 Oct. 39(10):2159-62. . Fenwick S. On atrophy of the stomach. Lancet . 1870. ii:78-80. Fine EJ, Hallett M. Neurophysiological study

2014 eMedicine.com

85. Intravenous Immunoglobulin (Treatment)

antibodies; natural antibodies can frequently bind to different antigens. [ ] Natural autoantibodies can (1) bind to pathogens; (2) help remove senescent or altered molecules, cells, and tumors; (3) induce remyelination; and (4) inhibit the growth of autoreactive B-cell clones. In the multifocal motor neuropathy disease state, IVIG intercedes to stop complement deposition that is triggered by anti-GM1 antibodies. [ ] The effect of IVIG could also relate to the presence of natural antibodies. IVIG also (...) , corticosteroid-resistant extensive, GCSF-induced Sweet syndrome. [ ] Miscellaneous Adrenoleukodystrophy Acute cardiomyopathy Congenital heart block Autoimmune blistering dermatosis Acute idiopathic dysautonomia Endotoxemia Hemophagocytic syndrome Lower motor neuron syndrome Human T-cell lymphotrophic virus-1–associated myelopathy Nephritic syndrome Membranous nephropathy Euthyroid ophthalmopathy Opsoclonus-myoclonus Recurrent Paraneoplastic cerebellar degeneration Paraproteinemic neuropathy (general

2014 eMedicine.com

86. Primary CNS Lymphoma (Follow-up)

30 cells/µL. Virtually all PCNSLs in patients with AIDS express an Epstein-Barr virus (EBV)-related genome. PCNSL is less frequently associated with EBV in patients without AIDS. The overwhelmingly common risk factor for PCNSL related to human immunodeficiency virus (HIV) infection is intravenous (IV) drug abuse. Corboy et al reported that 56% of a group of immunocompetent and immunocompromised patients had human herpes virus 8 (HHV-8) in their tumors. This is the same herpes virus (...) infected with HIV, and the incidence is expected to rise as patients with low CD4 + counts survive longer. Similar trends toward rising frequency of diagnosis of PCNSL are reported internationally. Sex predilection Among immunocompetent patients with PCNSL, males outnumber females by approximately 2:1. Almost 95% of HIV-infected patients with PCNSL are males. Age predilection The median age of immunocompetent patients with PCNSL is 55 years. The median age of HIV-infected patients with PCNSL is 35

2014 eMedicine.com

87. Opioid Abuse (Follow-up)

In general, the following complications may be observed. Opioid dependence: Constipation, noncardiac pulmonary edema (usually with heroin), and heroin-induced glomerulonephritis may occur. Combination products may lead to acetaminophen or aspirin toxicity. Related to IV drug use, multifocal leukoencephalopathy and myelopathy, which may be related to the parenteral route of administration rather than opioids; HIV; viral hepatitis; and bacteremia may occur. Right-sided endocarditis and valvular damage also (...) . The influence of prescription monitoring programs on chronic pain management. Pain Physician . 2009 May-Jun. 12(3):507-15. . . Brooks M. Grim stats for opioid-related deaths, prescribing in US. Medscape Medical News . July 2, 2014. . Opioid painkiller prescribing: where you live makes a difference. Centers for Disease Control and Prevention. Available at . Accessed: July 6, 2014. Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among States in prescribing of opioid pain relievers

2014 eMedicine.com

88. Neurosyphilis (Follow-up)

process known. Invasion of the CNS occurs early in the course of untreated syphilis. Of late, there has been a drastic increase, worldwide, in the incidence of syphilis, especially in urban areas. [ ] This fact leads clinicians to heighten their degree of suspicion, being profoundly alert to the possibility of this infection within the HIV populations. [ ] Neurosyphilis, quite directly, is defined as a CSF WBC count of 20 cells/µL or greater or a reactive CSF Venereal Disease Research Laboratory (VDRL (...) in whites than in blacks and is twice as common in males as in females. It is contracted most often during earlier years of sexual activity. Sometimes, not until decades later is the disease expressed clinically, as any of the myriad signs and symptoms within the spectrum of progressive chronic infection. In parts of Africa, the incidence may be in excess of 2300 cases per 100,000 population. In Nigeria, patients with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to therapy more

2014 eMedicine.com

89. Pathophysiology of Chronic Back Pain (Follow-up)

studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [ , , , , , ] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [ , ] Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common (...) first determine that pain symptoms are consistent with common activity-related disorders of the spine resulting from the wear and tear of excessive biomechanical and gravitational loading that some traditionally describe as mechanical. [ , ] Mechanical lumbar syndromes are typically aggravated by static loading of the spine (eg, prolonged sitting or standing), by long lever activities (eg, vacuuming or working with the arms elevated and away from the body), or by levered postures (eg, bending

2014 eMedicine.com

90. Intravenous Immunoglobulin (Follow-up)

antibodies; natural antibodies can frequently bind to different antigens. [ ] Natural autoantibodies can (1) bind to pathogens; (2) help remove senescent or altered molecules, cells, and tumors; (3) induce remyelination; and (4) inhibit the growth of autoreactive B-cell clones. In the multifocal motor neuropathy disease state, IVIG intercedes to stop complement deposition that is triggered by anti-GM1 antibodies. [ ] The effect of IVIG could also relate to the presence of natural antibodies. IVIG also (...) , corticosteroid-resistant extensive, GCSF-induced Sweet syndrome. [ ] Miscellaneous Adrenoleukodystrophy Acute cardiomyopathy Congenital heart block Autoimmune blistering dermatosis Acute idiopathic dysautonomia Endotoxemia Hemophagocytic syndrome Lower motor neuron syndrome Human T-cell lymphotrophic virus-1–associated myelopathy Nephritic syndrome Membranous nephropathy Euthyroid ophthalmopathy Opsoclonus-myoclonus Recurrent Paraneoplastic cerebellar degeneration Paraproteinemic neuropathy (general

2014 eMedicine.com

91. Transfusion-Transmitted Diseases (Follow-up)

is a major concern when it comes to transfusing immunocompromised hosts. For this reason, all immunocompromised patients are given CMV-seronegative or leukocyte-depleted blood products. [ , , , ] Human T-cell lymphotrophic virus Human T-cell lymphotrophic virus–1 (HTLV-1) and HTLV-2 have been shown to be transmitted by blood transfusion. The residual risk of transmission is 1 in 3 million in the United States. Infection with these retroviruses may result in HTLV-related myelopathy/ (HAM/TSP) and adult T (...) transmitted through blood transfusion include the following: Human immunodeficiency virus (HIV) West Nile virus (WNV) Cytomegalovirus (CMV) Human T-cell lymphotrophic viruses (HTLVs) Parvovirus B19 Protozoal organisms that can be passed on through transfusion include species of the genus Plasmodium , which cause malaria. Prions, which cause Creutzfeldt-Jakob disease, are also transmissible through transfusion; they cannot be destroyed using current techniques for inactivating pathogens in the blood supply

2014 eMedicine.com

92. Human T-Cell Lymphotrophic Viruses (Follow-up)

. J Clin Oncol . 2009 Jan 20. 27(3):453-9. . . Ramos JC, Lossos IS. Newly emerging therapies targeting viral-related lymphomas. Curr Oncol Rep . 2011 Oct. 13(5):416-26. . Yamauchi J, Coler-Reilly A, Sato T, Araya N, Yagishita N, Ando H, et al. Anti-CCR4 antibody mogamulizumab targets human T-lymphotropic virus type I-infected CD8+ as well as CD4+ T cells to treat associated myelopathy. J Infect Dis . 2014 Aug 7. . Nasr R, Marçais A, Hermine O, Bazarbachi A. Overview of Targeted Therapies for Adult (...) of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol . 2000 Sep. 100(3):245-52. . Beilke MA, Japa S, Moeller-Hadi C, Martin-Schild S. Tropical spastic paraparesis/human T leukemia virus type 1-associated myelopathy in HIV type 1-coinfected patients. Clin Infect Dis . 2005 Sep 15. 41(6):e57-63. . Berger JR, Svenningsson A, Raffanti S, Resnick L. Tropical spastic paraparesis-like illness occurring

2014 eMedicine.com

93. Human T-Cell Lymphotrophic Viruses (Diagnosis)

, HTLV-II, and HIV in injecting drug users in Salvador, Brazil. J Acquir Immune Defic Syndr Hum Retrovirol . 1998 Jun 1. 18(2):186-7. . Aye MM, Matsuoka E, Moritoyo T, et al. Histopathological analysis of four autopsy cases of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol . 2000 Sep. 100(3):245-52. . Beilke MA, Japa S, Moeller-Hadi C, Martin-Schild S. Tropical spastic paraparesis/human T (...) leukemia virus type 1-associated myelopathy in HIV type 1-coinfected patients. Clin Infect Dis . 2005 Sep 15. 41(6):e57-63. . Berger JR, Svenningsson A, Raffanti S, Resnick L. Tropical spastic paraparesis-like illness occurring in a patient dually infected with HIV-1 and HTLV-II. Neurology . 1991 Jan. 41(1):85-7. . Borg A, Yin JA, Johnson PR, Tosswill J, Saunders M, Morris D. Successful treatment of HTLV-1-associated acute adult T-cell leukaemia lymphoma by allogeneic bone marrow transplantation. Br J

2014 eMedicine.com

94. Arachnoiditis

, 2017 Author: Alan Holz, MD; Chief Editor: James G Smirniotopoulos, MD Share Email Print Feedback Close Sections Sections Arachnoiditis Imaging Practice Essentials Arachnoiditis is a broad term denoting inflammation of the meninges and subarachnoid space. It is characterized by thickening of the arachnoid membrane and dura mater adhesions that result in chronic lower back pain. Complications include cranial neuropathies, myelopathy, and radiculopathy. [ ] Arachnoiditis has many causes, including (...) Dec 16. 2016: . Panackal AA, Komori M, Kosa P, Khan O, Hammoud DA, Rosen LB, et al. Spinal Arachnoiditis as a Complication of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Adults. Clin Infect Dis . 2017 Feb 1. 64 (3):275-283. . Kondety SK, Chatterjee S. Acquired Chiari malformation secondary to tuberculous arachnoiditis of the lumbar spine. Neurol India . 2016 Sep-Oct. 64 (5):1066-8. . Chattopadhyay I, Jha AK, Banerjee SS, Basu S. Post-procedure adhesive arachnoiditis following

2014 eMedicine Radiology

95. Neurosyphilis (Diagnosis)

process known. Invasion of the CNS occurs early in the course of untreated syphilis. Of late, there has been a drastic increase, worldwide, in the incidence of syphilis, especially in urban areas. [ ] This fact leads clinicians to heighten their degree of suspicion, being profoundly alert to the possibility of this infection within the HIV populations. [ ] Neurosyphilis, quite directly, is defined as a CSF WBC count of 20 cells/µL or greater or a reactive CSF Venereal Disease Research Laboratory (VDRL (...) in whites than in blacks and is twice as common in males as in females. It is contracted most often during earlier years of sexual activity. Sometimes, not until decades later is the disease expressed clinically, as any of the myriad signs and symptoms within the spectrum of progressive chronic infection. In parts of Africa, the incidence may be in excess of 2300 cases per 100,000 population. In Nigeria, patients with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to therapy more

2014 eMedicine.com

96. Intravenous Immunoglobulin (Diagnosis)

antibodies; natural antibodies can frequently bind to different antigens. [ ] Natural autoantibodies can (1) bind to pathogens; (2) help remove senescent or altered molecules, cells, and tumors; (3) induce remyelination; and (4) inhibit the growth of autoreactive B-cell clones. In the multifocal motor neuropathy disease state, IVIG intercedes to stop complement deposition that is triggered by anti-GM1 antibodies. [ ] The effect of IVIG could also relate to the presence of natural antibodies. IVIG also (...) , corticosteroid-resistant extensive, GCSF-induced Sweet syndrome. [ ] Miscellaneous Adrenoleukodystrophy Acute cardiomyopathy Congenital heart block Autoimmune blistering dermatosis Acute idiopathic dysautonomia Endotoxemia Hemophagocytic syndrome Lower motor neuron syndrome Human T-cell lymphotrophic virus-1–associated myelopathy Nephritic syndrome Membranous nephropathy Euthyroid ophthalmopathy Opsoclonus-myoclonus Recurrent Paraneoplastic cerebellar degeneration Paraproteinemic neuropathy (general

2014 eMedicine.com

97. Pathophysiology of Chronic Back Pain (Diagnosis)

studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [ , , , , , ] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [ , ] Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common (...) first determine that pain symptoms are consistent with common activity-related disorders of the spine resulting from the wear and tear of excessive biomechanical and gravitational loading that some traditionally describe as mechanical. [ , ] Mechanical lumbar syndromes are typically aggravated by static loading of the spine (eg, prolonged sitting or standing), by long lever activities (eg, vacuuming or working with the arms elevated and away from the body), or by levered postures (eg, bending

2014 eMedicine.com

98. Transfusion-Transmitted Diseases (Diagnosis)

is a major concern when it comes to transfusing immunocompromised hosts. For this reason, all immunocompromised patients are given CMV-seronegative or leukocyte-depleted blood products. [ , , , ] Human T-cell lymphotrophic virus Human T-cell lymphotrophic virus–1 (HTLV-1) and HTLV-2 have been shown to be transmitted by blood transfusion. The residual risk of transmission is 1 in 3 million in the United States. Infection with these retroviruses may result in HTLV-related myelopathy/ (HAM/TSP) and adult T (...) transmitted through blood transfusion include the following: Human immunodeficiency virus (HIV) West Nile virus (WNV) Cytomegalovirus (CMV) Human T-cell lymphotrophic viruses (HTLVs) Parvovirus B19 Protozoal organisms that can be passed on through transfusion include species of the genus Plasmodium , which cause malaria. Prions, which cause Creutzfeldt-Jakob disease, are also transmissible through transfusion; they cannot be destroyed using current techniques for inactivating pathogens in the blood supply

2014 eMedicine.com

99. Polyarteritis Nodosa (Diagnosis)

in obstruction and subsequent tissue ischemia or infarction. [ ] Previous Next: Etiology Hepatitis B and PAN The pathogenesis of polyarteritis nodosa (PAN) is unknown, and no animal model is available for study. (HBV) infection is strongly linked with PAN. Evidence for immune complex–induced disease is confined to HBV-related PAN; the role of immune complexes in non-HBV-related PAN remains unclear. [ ] Impaired function of endothelial cells may be part of idiopathic PAN or a consequence of it; in HBV-PAN (...) in a larger 161 patient cohort with HCV-related vasculitis in France. [ ] Despite the presence of serum cryoglobulins, these patients were diagnosed with HCV-PAN on the basis of typical histopathologic features of PAN and/or the presence of microaneurysms and/or multiple stenoses on abdominal and/or renal angiography. A number of other infectious organisms have been reported in association with PAN or PAN-like diseases, but causal evidence is inconsistent. These organisms include varicella-zoster virus

2014 eMedicine.com

100. Polyarteritis Nodosa (Diagnosis)

in obstruction and subsequent tissue ischemia or infarction. [ ] Previous Next: Etiology Hepatitis B and PAN The pathogenesis of polyarteritis nodosa (PAN) is unknown, and no animal model is available for study. (HBV) infection is strongly linked with PAN. Evidence for immune complex–induced disease is confined to HBV-related PAN; the role of immune complexes in non-HBV-related PAN remains unclear. [ ] Impaired function of endothelial cells may be part of idiopathic PAN or a consequence of it; in HBV-PAN (...) in a larger 161 patient cohort with HCV-related vasculitis in France. [ ] Despite the presence of serum cryoglobulins, these patients were diagnosed with HCV-PAN on the basis of typical histopathologic features of PAN and/or the presence of microaneurysms and/or multiple stenoses on abdominal and/or renal angiography. A number of other infectious organisms have been reported in association with PAN or PAN-like diseases, but causal evidence is inconsistent. These organisms include varicella-zoster virus

2014 eMedicine.com

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