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Clinical Pathways
Focal Weakness
Focal Weakness

Focal Weakness

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Consider CNS causes for unilateral weakness:

  • Stroke
  • Tumor
  • Spinal cord lesion

If the CD4 count is <200 cells/mcL; consider:

  • Toxoplasmosis
  • CNS lymphoma
  • Abscess
  • Tuberculosis

(Class III)

Background

Evaluation of the HIV-infected patient with a neurologic complaint should be guided by the CD4 count. Patients with HIV infection, even if it is well-controlled, have a slightly higher risk of cerebrovascular disease. A 2018 systematic review identified a risk ratio for stroke of 2.56 (95% CI, 1.43-4.61) in patients living with HIV compared to non–HIV-infected persons.56^{56} This is likely multifactorial and secondary to the inflammatory state of the disease, atherosclerotic disease, smoking prevalence, and the metabolic effects of medications. The evaluation of patients with focal neurologic deficits should follow evidence-based stroke algorithms.

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References
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