SFGH 9.30 Neurology morning report pearls: HIV myelopathy/neuropathy

  • Whippits (AKA poppers)
    • small canisters of compressed nitrous oxide, intended for whipped cream dispensers, but abused as a recreational drug
    • prolonged use leads to functional inactivation of vitamin B12 through oxidation of cobalt ions
    • treat with high-dose IM B12 replacement (and counsel against whippit use!)
  • HIV myelopathy
    • path shows vacuolization in the lateral and posterior columns of the thoracic spinal cord
    • characterized by slowly progressive weakness of the lower extremities, gait disorder, sensory abnormalities in the legs, impotence in men, and urinary frequency and urgency
    • most common in late stages of AIDS
    • found in up to 30-50% of patients with AIDS at autopsy
  • HIV associated distal peripheral sensory neuropathy
    • most common neurological problem in AIDS
    • characterized by paresthesias (burning, numbness, shock-like sensations), ascending over time, also can involve the hands in a glove like fashion
    • decreased vibratory, temperature, and pinprick sensation
    • most don’t develop motor weakness or muscle wasting until late in the course
  • Jaw jerk: elicited by placing index finger over the middle of the patient’s chin with the mouth slightly open and the jaw relaxed.  the index finger is then tapped with a reflex hammer
    • tests sensory portion of trigeminal nerve and motor V3 branch of the trigeminal nerve
    • normal response: no significant movement of the jaw
    • abnormal response: jaw deviates toward the side of weakness; or pathologically brisk jerking of the jaw with lesions above the 5th nerve motor nucleus
DiRocco A, Simpson DM.  AIDS-associated vaculolar myelopathy.  AIDS Patient Care STDS.  1998 Jun; 12(6):457-61.
Singer EJ, Sueiras MV, Commins D, Levine, A  Neurologic Presentations of AIDS.  Neurol Clin 2010. Feb; 28(1) 253-275.
Thompson, AG, Leite MI, Lunn MP, Bennett DL.  Whippits, nitrous oxide and the dangers of legal highs.  Pract Neurol 2015; 15: 207-209.

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