AIDS and the neurosurgeon--an update.
Over the past decade, acquired immunodeficiency syndrome (AIDS) has become the leading public health crisis in the United States, Western Europe, and Africa. Despite improvements in the diagnosis and treatment of AIDS-related disorders, the number of people infected with the human immunodeficiency virus (HIV-1) continues to grow, requiring a greater proportion of limited financial, medical, and human resources. Since nearly one half of symptomatic AIDS patients have neuropathologic disease, clinicians must be aware of the myriad neurologic manifestations of AIDS and use the most effective methods to diagnose and treat them. The work-up of the AIDS patient with neurologic symptoms includes a careful history and physical examination, laboratory studies, and radiographic imaging. Gadolinium-enhanced magnetic resonance (MR) imaging has become the radiographic screening study of choice. MR imaging can be used to predict which patients should undergo stereotactic biopsy before an empirical trial of antitoxoplasmosis therapy. Any patient with a mass lesion that does not respond to empirical therapy for toxoplasmosis should also undergo biopsy to exclude another treatable disorder. While the number of patients with neurological complications can be expected to increase in the near future, better imaging techniques may obviate the need for biopsy in many of these patients. The increasing threat of HIV-1 infection in the workplace requires meticulous care both in and out of the operating room to minimize accidental exposure of health-care workers.
Ciricillo
S F
SF
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Rosenblum
M L
ML
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000601:surgery*; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000601:surgery*; D000465:Algorithms; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000601:surgery; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000601:surgery; D009422:Nervous System Diseases / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D016635:Universal Precautions