Clinical Pathways
Clinical Pathways
Non-focal weakness
Non-focal weakness

Non-focal weakness

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Decision

Weakness findings

Weakness is associated with upper motor neuron findings

(hyperactive reflexes, increased tone, spasticity)

Consider:

  • Spinal cord lesion
  • Spinal epidural abscess

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

  • HIV myelopathy

(Class III)

Weakness is associated with lower motor neuron findings

(absent reflexes, fasciculations, atrophy)

Consider:

  • Guillain-Barré syndrome
  • Cauda equina
  • Radiculopathy

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

  • HIV polyneuropathy

(Class III)

Weakness is generalized

Consider:

  • Electrolyte abnormalities
  • Sepsis
  • Hypothyroid
  • Adrenal insufficiency
  • Acute coronary syndromes
  • Dehydration
  • Myasthenia gravis
  • Botulism

(Class III)

Patient is on HAART

Consider medication-specific effects:

  • Renal impairment
  • Lactic acidosis
  • Anemia/bone marrow suppression
  • Dehydration from diarrhea

(Class III)

Background

CD4 counts and viral load results help to narrow the differential diagnosis in HIV-infected patients. In cases where patients have not had testing or do not know these values, there is a small amount of data that suggest an absolute lymphocyte count <950 cells/mcL may be associated with a CD4 count <200 cells/mcL, though guidelines do not advocate this as a true estimate.

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References
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