neurpathy w/hiv-aids

    
      Re: neurpathy w/hiv-aids
    


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Posted by CCF Neurology M.D. on February 09, 1998 at 03:47:03:

In Reply to: neurpathy w/hiv-aids posted by Donald Rodriguez on February 08, 1998 at 23:11:43:

: OK guys Ive got 1 for you. Ihave hiv/aids and Iam having a problem walkingmy motor skills somewhere down the line they say Ive lost them. Ive been to three nurolgist 2 of then only can say that there is something else wrong . Ive beeb test w/the needles 1 said its not drug related they have done a MRI of brain, stem,neck,and spine. Nothing was detected> Been tested for CMV that was negitive just did a Mylogram there are no pinched nerves everything looks good in there. I have enough strenght in my legs to walk but they say i dont have enough feeling to do so and my reflex reaction has a strange and usual jerk. Thats where they say something else is wrong Ive been unable to walk on my own ( I walk w/ a walker ) since 8/95. I suffer from on going Histoplasmosis and I am being treated with 20mg of amphotrericin once a week wityh 50mg demerol, 50 mg beidral,and 100mg solucortex. I take 100 evail for the numness and tinglin. My hiv drugs ( azt,epivir,norvir) cannot be the problem because i had the problem before i started taking them.
  I guess the big ? is would you have any other suggestions or can recommend anything else to look for. The last dr. I saw doesnt know what else to do.
  What are the possiblity of it being a kind of Tarsal Syndrome ?
  I guess i should sign it shooting in the dark
  Thank Don
Dear Don,
Approximately half of the patients with AIDS develop "peripheral neuropathies", that is, damage to the nerves that causes weakness and sensory changes. There are several ways in which they present.  The most common being distal sensorimotor (that is, numbness, tingling, occasionally pain and weakness beginning in the feet with symptoms fairly equal on both sides. The symptoms may gradually spread up the legs and eventually involve the hands).  There is also a subtype that has only sensory symptoms and no weakness. Both of these are thought to be mediated as a result of the HIV infection.  There are also several other patterns and reasons why neuropathies develop in a patient with AIDS: infectious (CMV, herpes, syphilis, mycobacterium), nutritional (B1 , folate,or other deficiences), a few immune mediated processes, and toxic related to meds (that may be additive to the already existing problem).  It sounds as if you have had a fairly significant work-up.  As you mentioned, your walking difficulties may be due to the sensory changes rather than the weakness (not knowing where your foot or leg is in space makes it very difficult walk irregardless of how strong you are). These symptoms are suggestive of a neuropathy. I doubt your symptoms are related to tarsel tunnel, which is caused by "trapping" one of the nerves to the foot behind the inside ankle.  It causes a burning pain in the toes and sole of the foot. There is also some wasting of the foot muscles. This syndrome is usually picked up as well as many neuropathies by an EMG exam.  Discuss this as will as other options with your doctors.