Headache in the HIV Patient: A Review with Special Attention to the Role of Imaging

Cb, Graham; Fj, Wippold

doi:10.1046/j.1468-2982.2001.00186.x

Cited by 12 publications

(16 citation statements)

References 38 publications

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“…Though all our patients had their CSF analyzed, head CT scan was done in only 77.3% (58/75) of patients albeit our CNS disease diagnostic algorithm, which defines an indication for head CT scans to all patients who present with symptoms of CNS disease. Despite the fact that most of our patients presented with headache and that the primary diagnostic procedure for headache in HIV positive subjects is neuroimaging,[2425] CT scanning still presents as a real challenge in sub-Saharan Africa where costs, access to diagnostic expertise and equipment are still limiting factors. [23] However, among those who could afford, the most common CT scan finding was cerebral edema.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

et al. 2013

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Background:Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.Aim:The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.Materials and Methods:A cross-sectional clinical note review of 672 HIV-1 patients’ files admitted from January 1 st 2004 to December 31 st 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.Results:The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).Conclusion:The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

et al. 2013

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“…In the appropriate context, neurosyphilis and tuberculosis may also cause either meningitis or focal brain lesions . As antiretroviral treatments have lead to improved immune restoration, a unique phenomenon has emerged in which patients started on effective cART experience a worsening due to the inflammatory reaction from a reconstituted immune response, termed immune reconstitution inflammatory syndrome (IRIS).…”

Section: Etiologymentioning

confidence: 99%

Clinical Aspects of Headache in HIV

Sheikh

Cho

2014

Headache

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Background Headaches are commonly seen in those patients with human immunodeficiency virus (HIV) and are the most common form of pain reported among HIV patients. There have been relatively few studies attempting to determine the rates and phenotypes of the headaches that occur in patients with HIV. Discussion Patients with HIV are susceptible to a much broader array of secondary headache causes, sometimes with atypical manifestations due to a dampened inflammatory response. The investigation of a headache in the HIV patient should be thorough and focused on making sure that secondary and HIV‐specific causes are either ruled out or treated if present. Conclusion An effective treatment plan should incorporate the use of appropriate pharmacological agents along with the integration of non‐pharmacological therapies, such as relaxation and lifestyle regulation. When treating for headaches in patients with HIV, it is important to keep in mind comorbidities and other medications, especially combination antiretroviral therapy. For those with complicated headache histories, referral to a specialized headache center may be appropriate.

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“…There are no formal guidelines for the appropriate workup for headache in patients infected with HIV. As such, in otherwise well individuals with CD4 + counts greater than 500 cells/mm 3 , the presence of so-called red flags for headache (i.e., sudden-onset headache, worst headache, progressive headache, headache associated with fever, or any associated neurologic signs) dictate the timing and degree of investigations [58,59]. In patients with CD4 + counts below 500 cells/mm 3 , a new or chronic headache necessitates neuroimaging followed by a CSF analysis (for routine chemistry, microscopy, cytologic analyses, culture and stains for bacteria, Mycobacterium spp, viruses, fungi, cryptococcal antigen titres, and Venereal Disease Research Laboratory test titres).…”

Section: Headache Attributed To Hiv/aidsmentioning

confidence: 99%

Headaches Attributable to Infectious Diseases

Gladstone¹,

Bigal

2010

Curr Pain Headache Rep

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Headache is the most common symptom that humans experience. While the vast majority of headaches are due to benign primary headache disorders, a small but important minority of headaches are due to secondary causes. Whereas significant emphasis is placed on educating physicians regarding prompt recognition of subarachnoid hemorrhage and headaches secondary to brain tumors, attention toward headaches secondary to infectious causes is often neglected. Unfortunately, a missed or delayed diagnosis of a headache secondary to meningitis, encephalitis, brain abscess, subdural empyema, or other infectious etiologies can lead to dire consequences for both the patient and physician. Accordingly, this article provides an overview of headaches attributed to systemic and intracranial infectious causes.

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Headache in the HIV Patient: A Review with Special Attention to the Role of Imaging

Abstract: Headache is one of the most commonly encountered neurologically related complaints in HIV patients. The authors review the relationship between HIV infection and headache and discuss the role of neuroimaging in this select patient group.

Cited by 12 publications

References 38 publications

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

Clinical Aspects of Headache in HIV

Headaches Attributable to Infectious Diseases

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