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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.
Conclusion: 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.
Footnotes
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Study funding: Supported by a Sylvia Lawry Physician Fellowship from the National Multiple Sclerosis Society (S.D.N.) and NIH R01 DA024593 (A.N.).
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- CART
- combined antiretroviral therapy
- FLAIR
- fluid-attenuated inversion recovery.
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Supplemental data at www.neurology.org
- Received June 25, 2010.
- Accepted November 12, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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- Fulminant encephalopathy with basal ganglia hyperintensities in HIV-infected drug users
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