RECURRENT TRANSIENT NEUROLOGICAL DEFICITS IN ADVANCED HIV-INFECTION

Objectives: To report the occurrence of a syndrome of recurrent neurological deficits in advanced HIV disease and to discuss its management and prognosis. Design: Retrospective case study. Setting: A regional treatment centre for HIV-infected individuals in northwest England. Main outcome measures: Transient neurological deficit was defined as a focal neurological deficit of rapid onset which resolved completely within 24 h. Frequency, character and duration of episodes were recorded. Prior illnesses, CD4 count, changes in drug therapy and brain imaging investigations were also documented. Results: Seven cases with recurrent transient neurological deficits were identified among 748 patients over a 10-year period. Six had a CD4 cell count < 50 x 10(6)/l. The episodes lasted between 1 and 12 h and resolved completely without lasting sequelae. Dysphasia and hermiparesis were the most common presentations. Recurrent episodes for each patient tended to follow a similar pattern. None had computed tomographic evidence of cerebral infarction or clinical evidence of completed stroke. Prognosis was varied and not evidently altered by the episodes of neurological deficit. Three patients may have benefited from treatment with migraine prophylactics. Conclusion: A syndrome of recurrent transient neurological deficits may occur tn advanced HIV disease. We believe that in some cases this may be due to local cerebral vasospasm, comparable to a classic migraine aura.