title: Fulminant encephalopathy with basal ganglia hyperintensities in HIV-infected drug users.
abstract: OBJECTIVE
  To define a clinical syndrome associated with active drug abuse in HIV-infected individuals.
  
  
  METHODS
  We performed a retrospective review to identify individuals treated at the Johns Hopkins Hospital from 1993 to 2008 who were HIV-infected and were actively abusing drugs and had bilateral basal ganglia lesions on MRI. They were identified using a key word search in the radiology database, autopsy database, and the Moore HIV clinic database. Clinical, laboratory, and radiographic findings were correlated to define the syndrome.
  
  
  RESULTS
  Ten individuals were identified who presented with a change in mental status or seizures, used cocaine or cocaine with heroin, had uncontrolled HIV infection (>190,000 copies/mL of plasma), elevated CSF protein (63-313 mg/dL), and diffuse hyperintense bilateral basal ganglia lesions on imaging. The majority of patients (8/10) had renal failure and despite supportive therapy most (7/9) ultimately died (median survival 21 days). Postmortem examination in one individual showed the presence of overwhelming microglial activation in the basal ganglia. The 2 surviving individuals were started on combined antiretroviral therapy (CART) during hospitalization.
  
  
  CONCLUSIONS
  We describe a unique clinical syndrome of a fulminant encephalopathy associated with primarily basal ganglia involvement in HIV-infected drug abusers. This syndrome is a rare but serious condition that is associated with a high mortality rate. Early CART institution may be useful and neuroprotective in this disorder, although this requires further investigation.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Newsome
authors.forename: E
authors.initials: E
authors.lastname: Johnson
authors.forename: C
authors.initials: C
authors.lastname: Pardo
authors.forename: J C
authors.initials: JC
authors.lastname: McArthur
authors.forename: A
authors.initials: A
authors.lastname: Nath
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications / Q000473:pathology*; D000328:Adult; D001479:Basal Ganglia / Q000473:pathology*; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000473:pathology*; D013577:Syndrome