Movement disorders as presenting symptoms of AIDS

Hemichorea-Hemiballismus as a Presentation of Cerebritis from Intracranial Toxoplasmosis and Tuberculosis

“…While we could not entirely discount its benefit in the acute phase, long-term symptomatic therapy with risperidone was no longer necessary in our case as this is commonly reserved for those with persistent or disabling symptoms [ 4 37 ]. Although response of chorea-ballism to antitoxoplasmosis and anti-TB therapy is variable [ 1 4 20 ], the marked improvement seen in our patient may attest to the reversible nature of AIDS-related HCHB, as is often seen after treatment [ 4 ]. Other factors that may affect overall prognosis of intracranial toxoplasmosis and TB include timing of diagnosis and therapy, clinical stage of the disease, and progression of neurological involvement [ 20 31 35 ].…”

“…Currently, there are no studies describing their interplay as an underlying mechanism for HCHB, whether in the presence or absence of HIV infection. Acute disruption and altered firing rate of the STN and its efferent pathways due to a destructive focus, in addition to the direct effects of HIV on the basal ganglia circuitry, possibly contribute to the pathogenesis of chorea-ballism in this population [ 2 20 27 28 37 43 ]. As is usually the case among AIDS patients, multiple conditions may affect a portion of the nervous system simultaneously [ 36 ] and it is imperative to address these with adequate antimicrobial therapy.…”