19-§3-Paralysis & Paresis
Think also about stroke and hematoma of course, especially if symptoms arise
acutely (paralysis occurs within a few minutes or few hours). HIV infection
increases the risk of stroke and increases the risk of falling and causing a
cerebral hematoma (because of weakness, hemostatic problems, etc.)
First question: is paresis/paralysis symmetrical
If symmetrical paresis/paralysis: (bad prognosis!)
- HIV dementia? (See "HIV Dementia “)
- Inflammatory demyelinating polyneuropathies (including "Guillain-Barre Syndrome")? Or polyradiculitis?
Ascending symmetrical paralysis with weak reflexes or no reflexes.
Bowel/bladder incontinence is possible. Treatment is supportive...
Prognosis is poor... Just wait and see with symptomatic care... Demyelinating
disease can resolve 100% but it is rare in our ward. Note: the diseases
can give mild asymmetrical signs during evolution that is not always linear
in time (partial relapse of some symptoms during recovery phase).
- Vacuolar myelopathy? Ascending symmetrical
paralysis with hyper-reflexive legs (spastic). Stiffness in legs.
Babinski (+). Bowel and bladder incontinence... Prognosis very
poor. No treatment. Death usually comes within only a few days/weeks...
- Symmetrical paralysis is rare but possible with
toxo, lymphoma, TB... (Depends on location of tumors)
If asymmetrical paresia/paralysia: (nxx001)
- Toxoplasmosis +/- headache, +/-fever (See "19-§2-Toxo")
Treatment is cheap.
- Cerebral TB Irregular fever, loss of weight, etc.
Treatment is possible.
- Lymphoma. No fever! Possible diagnosis if toxo treatment test
is negative! (See "19-§2-Lymphoma"). No treatment is affordable/available
in a poor hospice.
- Progressive multifocal leukoencephalopathy ("PML")
No headache! Possible diagnosis if toxo treatment test and TB treatment
test are both negative! (See "19-§2-PML") No treatment is affordable/available
in a poor hospice.
- Asymmetrical paralysis is possible with Neurosyphilis,
but not in cryptococcal meningitis