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 or not?

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) (nxx003...)

• Toxoplasmosis +/- headache, +/-fever (See "19-§2-Toxo") Treatment is cheap.
• Cerebral TB Irregular fever, loss of weight, etc. (See "31-Tuberculosis") 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, HIV dementia but not in cryptococcal meningitis