Book Review

AIDS and Neurology

N Engl J Med 1996; 334:1750June 27, 1996

Article

AIDS and Neurology
(Clinical Neurology and Neurosurgery Monographs.) Edited by Michael J.G. Harrison and Justin C. McArthur. 262 pp., illustrated. New York, Churchill Livingstone, 1996. $110. ISBN: 0-443-04896-7

Like the “great imposter,” syphilis, in earlier times, the human immunodeficiency virus (HIV) challenges the clinician to develop a broad spectrum of clinical expertise. Over the past 10 years, a substantial body of knowledge has developed regarding neurologic involvement in HIV infection. Every level of neural organization is affected, including the brain (in encephalitis), spinal cord (in myelitis), peripheral nerves (in neuropathy), and muscles.

The complexity of the neural involvement in AIDS increases with the development of immunodeficiency during the course of the infection. Long-term immunodeficiency results in serious opportunistic infections that may be confused with primary neurologic HIV disease and that in themselves represent a difficult diagnostic and therapeutic challenge. Diseases such as toxoplasma encephalitis, progressive multifocal leukoencephalitis, cryptococcal meningitis, and primary cytomegalovirus encephalitis are commonly encountered. “Neuro-AIDS” has become a subspecialty in neurology, but knowledge about this field was until recently either unavailable or esoteric.

Harrison and McArthur have made notable contributions to this field. This new monograph provides a very useful summary of neurologic disorders in AIDS. The editors have organized the primary manifestations of HIV according to levels of neurologic organization. The discussion of AIDS dementia complex is well balanced, with a fine synthesis of opinion regarding this condition and references to the literature behind the synthesis up to 1995. Spinal cord disease, peripheral-nerve disease, and muscle disease are addressed in turn. The subsequent chapters review the neurologic opportunistic and neoplastic conditions common in patients with HIV and include both diagnostic and therapeutic recommendations. The concluding chapters provide a useful collection of data, and methods of neurologic diagnosis are discussed in relation to their usefulness in the setting of HIV. Appendixes provide research definitions and classifications applied to HIV disease, recommended treatment regimens, descriptions of psychiatric side effects of medications, and even a review of universal precautions.

David B. Clifford, M.D.
Washington University School of Medicine, St. Louis, MO 63110