Notes: HIV associated peripheral neuropathy
MRCP neuro station
Please examine patient lower limb
Question: This patient is underlying RVD positive presenting to you with bilateral lower limb weakness.
This RVD patient has walking problems.
- IV injection marks
- Is there loss of muscle bulk to show chronic of the disease?
- Gait- Bilateral foot drop
- Thickening of the peroneal nerve
- Heel to shin test
- Diminished reflexes- diminished ankle reflex
- Sensory loss- pin prick – callouses
- Loss to vibration sense
- Loss to propioception ( I wonder which one would be better elicited if the pathology is posterior dorsal column)
- In articles it mention – temporal progression of peripheral sensory loss, loss of vibration sense then loss of temperature then loss of pain.
- Calosities ? signs of thickend or hardened skin
I would to offer my differential diagnosis
- Syphillis – neurosyphillis
- Non ARV associated neuopathy, – Isoniazide
- DM –
- Caudate equina syndrome- just to make it official the emergency diagnosis are excluded
- Diffuse infiltrative lymphocytosis
- Cryoglobilinimiea underlyng Hep C
- ? Leprosy – thickened peroneal nerve, with sensory hypoaesthisia and foot drop.
- TRO central causes – CT myelogram, MRI spine better define lesion, CT brain look for parasagital meningioma
- NCS, EMG, Biopsy nerve and muscle