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HIV related Myelopathy

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81. Human T-Cell Lymphotrophic Viruses (Treatment)

. 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

82. Primary CNS Lymphoma (Treatment)

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 (...) , Little RF, et al. Paradoxical central nervous system immune reconstitution syndrome in acquired immunodeficiency syndrome-related primary central nervous system lymphoma. Haematologica . 2014 Oct 10. . Corboy JR, Garl PJ, Kleinschmidt-DeMasters BK. Human herpesvirus 8 DNA in CNS lymphomas from patients with and without AIDS. Neurology . 1998 Feb. 50(2):335-40. . Gomez-Brouchet A, Delisle MB, Vital A, Brousset P. Immunohistochemical assessment of human herpesvirus 8 infection in primary central

2014 eMedicine.com

83. Intravenous Immunoglobulin (Treatment)

, 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 (...) remains unproven. IVIG does not prevent further losses among women with primary, recurrent, spontaneous pregnancy loss. IVIG is a useful treatment for immunodeficiencies with a greater role than simple replacement therapy. [ ] One study suggests that IVIGs are effective in the treatment of pretibial myxedema and may have immunomodulatory action in patients with Graves disease and related disorders. Patients with ataxic sensory neuronopathy with Sjögren syndrome and stiff man syndrome have benefited

2014 eMedicine.com

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

in infantile cobalamin deficiency appearing after treatment. Pediatr Neurol . 2001 Jul. 25(1):81-3. . Paltiel O, Falutz J, Veilleux M. Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. Am J Hematol . 1995 Aug. 49(4):318-22. . Pant SS, Asbury AK, Richardson EP Jr. The myelopathy of pernicious anemia. A neuropathological reappraisal. Acta Neurol Scand . 1968. 44:Suppl 5:1-36. . Penix LP. Ischemic strokes secondary to vitamin B12 deficiency-induced (...) . MRI of spinal cord and brain lesions in subacute combined degeneration. Neuroradiology . 1998 Nov. 40(11):716-9. . Kieburtz KD, Giang DW, Schiffer RB, Vakil N. Abnormal vitamin B12 metabolism in human immunodeficiency virus infection. Association with neurological dysfunction. Arch Neurol . 1991 Mar. 48(3):312-4. . Kirke PN, Molloy AM, Daly LE. Maternal plasma folate and vitamin B12 are independent risk factors for neural tube defects. Q J Med . 1993 Nov. 86(11):703-8. . Krumholz A, Weiss HD

2014 eMedicine.com

85. Pathophysiology of Chronic Back Pain (Treatment)

. In humans, painful disks have a lower pH than nonpainful disks. Also, experimental lowering of the pH in animal models induced pain-related behaviors and hyperalgesia. Diskography of canine disks that were normally or experimentally deformed seemed to show increased concentrations of neuropeptides, such as substance P (SP), calcitonin gene-related peptide (CGRP), and vasoactive intestinal peptide (VIP) in the dorsal root ganglion (DRG), implicating their possible role in the transmission or modulation (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0NDEzMC1vdmVydmlldw== processing > Low Back Pain and Sciatica Updated: Aug 22, 2018 Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA Share Email Print Feedback Close Sections Sections Low Back Pain and Sciatica Overview Overview Like a modern skyscraper, the human spine defies gravity, and defines us as vertical bipeds. It forms the infrastructure of a biological machine that anchors the kinetic chain and transfers biomechanical forces into coordinated functional activities

2014 eMedicine.com

86. Transfusion-Transmitted Diseases (Treatment)

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 (...) of contamination. A negative culture for 24-48 hours before the product is released for transfusion is highly recommended. Previous Next: Viral Infections Human immunodeficiency virus The human immunodeficiency virus (HIV), a member of the Lentivirus family of retroviruses, is the causative agent of acquired immunodeficiency syndrome (AIDS). In the United States, more than 1.2 million people are living with HIV, and 1 in 8 of them don't know it. Individuals who engage in male-male sexual behavior accounted

2014 eMedicine.com

87. Neurosyphilis (Treatment)

> Neurosyphilis Overview of Syphilis of the CNS Updated: Jul 17, 2018 Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Share Email Print Feedback Close Sections Sections Neurosyphilis Overview of Syphilis of the CNS Overview of Syphilis of the CNS Syphilis is a sexually transmitted disease caused by Treponema pallidum, with human beings as the only host. Syphilitic infection of the nervous system results in the most chronic, insidious meningeal inflammatory (...) 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

2014 eMedicine.com

88. Primary CNS Lymphoma (Overview)

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 (...) , Little RF, et al. Paradoxical central nervous system immune reconstitution syndrome in acquired immunodeficiency syndrome-related primary central nervous system lymphoma. Haematologica . 2014 Oct 10. . Corboy JR, Garl PJ, Kleinschmidt-DeMasters BK. Human herpesvirus 8 DNA in CNS lymphomas from patients with and without AIDS. Neurology . 1998 Feb. 50(2):335-40. . Gomez-Brouchet A, Delisle MB, Vital A, Brousset P. Immunohistochemical assessment of human herpesvirus 8 infection in primary central

2014 eMedicine.com

89. Pathophysiology of Chronic Back Pain (Overview)

. In humans, painful disks have a lower pH than nonpainful disks. Also, experimental lowering of the pH in animal models induced pain-related behaviors and hyperalgesia. Diskography of canine disks that were normally or experimentally deformed seemed to show increased concentrations of neuropeptides, such as substance P (SP), calcitonin gene-related peptide (CGRP), and vasoactive intestinal peptide (VIP) in the dorsal root ganglion (DRG), implicating their possible role in the transmission or modulation (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0NDEzMC1vdmVydmlldw== processing > Low Back Pain and Sciatica Updated: Aug 22, 2018 Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA Share Email Print Feedback Close Sections Sections Low Back Pain and Sciatica Overview Overview Like a modern skyscraper, the human spine defies gravity, and defines us as vertical bipeds. It forms the infrastructure of a biological machine that anchors the kinetic chain and transfers biomechanical forces into coordinated functional activities

2014 eMedicine.com

90. Polyarteritis Nodosa (Overview)

, parvovirus B-19, cytomegalovirus, human T-cell leukemia virus, streptococcal species, Klebsiella species, Pseudomonas species, Yersinia species, Toxoplasma gondii , Rickettsiae, trichinosis, and sarcosporidiosis. [ , ] Recently, reports of associations with PAN and human immunodeficiency virus [ ] and cutaneous PAN and tuberculosis [ ] have been published as well. Some syndromes, including rheumatic diseases, malignancies, and infections have been associated with clinical syndromes indistinguishable from (...) 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

91. Polyarteritis Nodosa (Overview)

, parvovirus B-19, cytomegalovirus, human T-cell leukemia virus, streptococcal species, Klebsiella species, Pseudomonas species, Yersinia species, Toxoplasma gondii , Rickettsiae, trichinosis, and sarcosporidiosis. [ , ] Recently, reports of associations with PAN and human immunodeficiency virus [ ] and cutaneous PAN and tuberculosis [ ] have been published as well. Some syndromes, including rheumatic diseases, malignancies, and infections have been associated with clinical syndromes indistinguishable from (...) 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

92. Neurosyphilis (Overview)

> Neurosyphilis Overview of Syphilis of the CNS Updated: Jul 17, 2018 Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Share Email Print Feedback Close Sections Sections Neurosyphilis Overview of Syphilis of the CNS Overview of Syphilis of the CNS Syphilis is a sexually transmitted disease caused by Treponema pallidum, with human beings as the only host. Syphilitic infection of the nervous system results in the most chronic, insidious meningeal inflammatory (...) 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

2014 eMedicine.com

93. Somatosensory Evoked Potentials: Clinical Applications (Treatment)

for detecting abnormalities Vascular lesions Tumors Myelomeningocele Tethered cord syndrome Infectious disorders (eg, human T-lymphocytic virus 1 and HIV) Previous Next: Brain Stem and Brain Brain stem lesions and stroke SEPs are normal in Wallenberg's syndrome but are generally abnormal when medial lemniscus is involved. SEPs are also unaffected and normal in some of the hemispheric (eg, pure motor lacunar infarctions, occipital lobe infarctions). In larger brainstem or hemispheric lesions, N20 and later (...) 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

2014 eMedicine.com

94. Retinitis, CMV (Overview)

eye involvement and retinal detachment. Ophthalmology . 2004 Dec. 111(12):2232-9. . Banker AS. Posterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. Indian J Ophthalmol . 2008 Sep-Oct. 56 (5):377-83. . Wong JX, Wong EP, Teoh SC. Outcomes of cytomegalovirus retinitis-related retinal detachment surgery in acquired immunodeficiency syndrome patients in an Asian population. BMC Ophthalmol . 2014 Nov 27. 14:150. . Stewart MW. Optimal management (...) in patients with human immunodeficiency virus infection. Rev Gastroenterol Disord . 2002 Fall. 2 (4):176-88. . Baumal CR, Levin AV, Read SE. Cytomegalovirus retinitis in immunosuppressed children. Am J Ophthalmol . 1999 May. 127(5):550-8. . Sugar EA, Jabs DA, Ahuja A, Thorne JE, Danis RP, Meinert CL. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol . 2012 Jun. 153(6):1016-1024.e5. . . Kempen JH, Sugar EA, Lyon AT, Lewis RA, Jabs DA, Heinemann MH

2014 eMedicine.com

95. Intravenous Immunoglobulin (Overview)

, 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 (...) remains unproven. IVIG does not prevent further losses among women with primary, recurrent, spontaneous pregnancy loss. IVIG is a useful treatment for immunodeficiencies with a greater role than simple replacement therapy. [ ] One study suggests that IVIGs are effective in the treatment of pretibial myxedema and may have immunomodulatory action in patients with Graves disease and related disorders. Patients with ataxic sensory neuronopathy with Sjögren syndrome and stiff man syndrome have benefited

2014 eMedicine.com

96. Transfusion-Transmitted Diseases (Overview)

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 (...) of contamination. A negative culture for 24-48 hours before the product is released for transfusion is highly recommended. Previous Next: Viral Infections Human immunodeficiency virus The human immunodeficiency virus (HIV), a member of the Lentivirus family of retroviruses, is the causative agent of acquired immunodeficiency syndrome (AIDS). In the United States, more than 1.2 million people are living with HIV, and 1 in 8 of them don't know it. Individuals who engage in male-male sexual behavior accounted

2014 eMedicine.com

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

. In humans, painful disks have a lower pH than nonpainful disks. Also, experimental lowering of the pH in animal models induced pain-related behaviors and hyperalgesia. Diskography of canine disks that were normally or experimentally deformed seemed to show increased concentrations of neuropeptides, such as substance P (SP), calcitonin gene-related peptide (CGRP), and vasoactive intestinal peptide (VIP) in the dorsal root ganglion (DRG), implicating their possible role in the transmission or modulation (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0NDEzMC1vdmVydmlldw== processing > Low Back Pain and Sciatica Updated: Aug 22, 2018 Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA Share Email Print Feedback Close Sections Sections Low Back Pain and Sciatica Overview Overview Like a modern skyscraper, the human spine defies gravity, and defines us as vertical bipeds. It forms the infrastructure of a biological machine that anchors the kinetic chain and transfers biomechanical forces into coordinated functional activities

2014 eMedicine.com

98. 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 (...) Psychiatric Association. Practice guideline for the treatment of patients with substance use disorders, 2nd edition. In American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. Arlington, VA: American Psychiatric Association, 2006 (pp. 291–563). Available at . Younger JW, Chu LF, D'Arcy NT, et al. Prescription opioid analgesics rapidly change the human brain. Pain . 2011 Aug. 152(8):1803-10. . . Brooks M. FDA clears hydrocodone with abuse-deterrent

2014 eMedicine.com

99. 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 (...) , Little RF, et al. Paradoxical central nervous system immune reconstitution syndrome in acquired immunodeficiency syndrome-related primary central nervous system lymphoma. Haematologica . 2014 Oct 10. . Corboy JR, Garl PJ, Kleinschmidt-DeMasters BK. Human herpesvirus 8 DNA in CNS lymphomas from patients with and without AIDS. Neurology . 1998 Feb. 50(2):335-40. . Gomez-Brouchet A, Delisle MB, Vital A, Brousset P. Immunohistochemical assessment of human herpesvirus 8 infection in primary central

2014 eMedicine.com

100. Intravenous Immunoglobulin (Follow-up)

, 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 (...) remains unproven. IVIG does not prevent further losses among women with primary, recurrent, spontaneous pregnancy loss. IVIG is a useful treatment for immunodeficiencies with a greater role than simple replacement therapy. [ ] One study suggests that IVIGs are effective in the treatment of pretibial myxedema and may have immunomodulatory action in patients with Graves disease and related disorders. Patients with ataxic sensory neuronopathy with Sjögren syndrome and stiff man syndrome have benefited

2014 eMedicine.com

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