Page 188 - AIDSBK23C

Page 188

PERIPHERAL NERVE AND MUSCLE PATHOLOGY IN AIDS

PERIPHERAL NERVE.-- Many HIV-infected persons develop peripheral neuropathies
and muscular weakness that can be detected through careful history and neurologic examination.
The etiology is more than just muscle wasting from debilitation, for there may be clinical signs
and symptoms of pain, paresthesias, electromyographic abnormalities, elevated creatine kinase,
and muscle group atrophy.[808]
Criteria have been established for the clinical diagnosis of HIV-1-associated peripheral
nervous system disorders. This classification requires laboratory evidence for HIV-1 infection
for diagnosis.[809]

I. HIV-1-associated acute inflammatory demyelinating polyradiculopathy (HIV-1-
associated Guillain-Barré syndrome)

PROBABLE (must have):

1. Guillain-Barré syndrome by previously published criteria, except:

3
CSF mononuclear leukocyte count can be as high as 50 cells per mm

POSSIBLE (must have):

1. Other potential etiology present (must have each of the following):

a. As above (see Probable) #1.
b. Other potential etiology is present and the cause of (see Probable)
#1 is uncertain.

2. Incomplete clinical evaluation (must have each of the following):

a. As above (see Probable) #1.
b. Etiology cannot be determined (appropriate laboratory
investigations not performed).

II. HIV-1-associated predominantly sensory polyneuropathy

PROBABLE (must have each of the following):

1. Distal limb sensory symptoms (feet > hands) of a peripheral nerve nature
(e.g., numbness, burning, or pain).

2. Neurologic examination confirming a distal, relatively symmetric
polyneuropathy in which sensory abnormalities predominate.