[Neurologic disturbances in human immunodeficiency virus carriers in Yaoundé].

Neurological manifestations are frequent with the acquired immunodeficiency syndrome (AIDS). They can be seen at the onset of the illness but more often they are found during its terminal phase. The aim of this study is to describe the neurological complications observed in AIDS as well as the evolution in the intensive care unit of the Yaounde General Hospital, Republic of Cameroon. This prospective study was carried out during a two-year period at the intensive care unit. All patients who were HIV-positive and who presented a neurological disorder diagnosed during the interrogation and clinical examination were included in this study. In these patients, the following paraclinical examinations were performed: ocular fundi, CD4 lymphocytes titre, toxoplasmosis serology, lumbar tap, and cerebral scan. A diagnosis was made and the patients were treated accordingly. The appreciation of the evolution was done in relation with the clinical state and the mortality observed in the service. We recruited 51 patients in all, aged 38 years on average (+/- 7 years). There were 31 women and 20 men. The neurological disorders observed were 26 states of coma, 14 agitations with mental confusion, 6 meningitis syndromes, 5 hallucinations. The titre of CD4 showed an average of 146/mm3 (+/- 12). Toxoplasmosis serology was positive for 6 patients. The cerebrospinal fluid revealed 2 cases of purulent meningitis. The ocular fundi showed 5 cases of papillary oedema. The cerebral scan showed 8 cases of cerebral abscess, 4 cases of cerebral tumour and 6 cases of cerebral toxoplasmosis. These paraclinical findings have enabled us to establish the following classification of the patients: cerebral tumors (n=4); bacterial meningitis (n=2); aseptic meningitis (n=10); cerebral toxoplasmosis (n=6); sub-acute encephalopathy (n=21); cerebral abscess (n=8). These patients were treated according to the diagnosis. The clinical evolution was marked by recovery in 14 patients with improved clinical state and by mortality in 34 patients. Many neurological disorders exist in HIV infections. These complications vary according to the stage of the illness. They are caused either by opportunistic infections, by tumours or by the virus itself. The most frequent complication in our service is sub-acute encephalitis, which induces coma. This is due to the fact that the intensive care unit receives terminal patients coming from other services. This late recruitment of patients also explains the high mortality rate. Copyright John Libbey Eurotext 2003