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Movement disorders in 28 HIV-infected patients
James Pitágoras de Mattos1, Ana Lúcia Zuma de Rosso, Rosalie Branco Correa
1Movement Disorders Sector, Department of Neurology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro.
Abstract:
From 1986 to 1999, 2460 HIV-positive inpatients were seen in our Hospital. Neurological abnormalities were detected in 1053 (42.8%) patients. In this group, 28 (2.7%) had involuntary movements, 14 (50%) with secondary parkinsonism, six (21.4%) with hemichorea/hemiballismus, four (14.2%) with myoclonus, two (7.2%) with painful legs and moving toes, one (3.6%) with hemidystonia and one (3.6%) with Holmes' tremor. The HIV itself (12 patients), toxoplasmosis of the midbrain (1) and metoclopramide-related symptoms (1) were the most probable causes for the parkinsonism. All patients with hemichorea/hemiballismus were men and in all of them toxoplasmosis of the basal ganglia, mostly on the right side, was the cause of the involuntary movements. Generalized myoclonus was seen in two patients and they were due to toxoplasmosis and HIV-encephalopathy respectively; two others presented with spinal myoclonus. The two patients with painful legs and moving toes had an axonal neuropathy. The patient with hemidystonia suffered from toxoplasmosis in the basal ganglia and the patient with Holmes' tremor had co-infection with tuberculosis and toxoplasmosis affecting the midbrain and cerebellum. We conclude that HIV-infected patients can present almost any movement disorder. They can be related to opportunistic infections, medications, mass lesions and possibly to a direct or indirect effect of the HIV itself.
Insights
Human immunodeficiency virus (HIV) infection can cause diverse neurological movement disorders. These symptoms, including parkinsonism and hemichorea, are often linked to opportunistic infections or the virus itself.
Area of Science:
- Neurology
- Infectious Diseases
- Movement Disorders
Background:
- Neurological abnormalities are common in patients with human immunodeficiency virus (HIV).
- Movement disorders represent a significant subset of these neurological complications.
Purpose of the Study:
- To investigate the spectrum and causes of involuntary movement disorders in HIV-positive inpatients.
- To determine the association of specific movement disorders with opportunistic infections, HIV, and medications.
Main Methods:
- Retrospective analysis of 2460 HIV-positive inpatients from 1986 to 1999.
- Detailed neurological examination and documentation of involuntary movements.
- Identification of potential etiologies including opportunistic infections and HIV itself.
Main Results:
- 42.8% of HIV patients had neurological abnormalities; 2.7% presented with involuntary movements.
- Secondary parkinsonism (50%), hemichorea/hemiballismus (21.4%), and myoclonus (14.2%) were the most frequent movement disorders.
- Toxoplasmosis was a common cause, particularly for hemichorea/hemiballismus and hemidystonia. HIV-encephalopathy and co-infections were also implicated.
Conclusions:
- HIV-infected individuals can exhibit a wide range of movement disorders.
- Opportunistic infections, particularly toxoplasmosis, are major contributors to these disorders.
- Movement disorders in HIV patients can also result from direct HIV effects, medications, or co-infections.