In patients infected with HIV, the whole neuraxis is vulnerable to damage. Up to 10% of patients may present with a neurological disorder at seroconversion (Box 8.1). The aseptic meningoencephalitis, which is usually self limiting, presents with headache, meningism, cranial nerve palsies and seizures. An acute demyelinating polyradiculoneuropathy (Guillain—Barre syndrome) is identical to that found in non-HIV-infected individuals, clinically and in the response to treatment with intravenous immunoglobulin or plasmapharesis. However, the cerebrospinal fluid shows a pleocytosis of over 20 cells/mm3 which is unusual in non HIV cases. A high index of suspicion is required and HIV should be considered in all such cases.
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