Neurosurgical complications of HIV

Among patients with AIDS, 10% will have signs of neurological dysfunction at first presentation, with 60% ultimately manifesting signs of neurological disease sometime during the course of their illness. The neurosurgical manifestations of this disease may be related to secondary infection, direct nervous system invasion or HIV-associated neoplasms. These complications present as either focal mass lesions of the brain and spine or cerebrospinal fluid (CSF) flow disturbances. As most focal lesions are treatable medically, neurosurgical intervention seldom exceeds biopsy, abscess aspiration or CSF diversion. Conditions commonly encountered in South Africa relate to reactivation of opportunistic infections, with or without hydrocephalus. Neoplasms occur somewhat less frequently. Given South Africa’s high tuberculosis (TB) prevalence, TB-related illnesses are common – either TB meningitis and/or TB abscess. Spinal TB is also common and presents as spondylodiscitis with a paravertebral psoas abscess. Nocardia, Aspergillus and Candida may all present with meningo-encephalitis, or as intracranial mass lesions.