A brief overview of common causes of neurological complications that can cause secondary changes in the mental state is presented; this is followed by a guide for features of acute changes in mental state that may occur and the management of these changes before discussing the mental complications of HIV/AIDS.
11.1a: Focal neurological changes suggestive of a mass lesion
• Urgent consideration should be given to all patients presenting with changes in mental state, new onset seizures, or fever and neck stiffness.
• Clinical assessment for evidence of focal neurological signs and increased intracranial pressure should be made before attempting a lumber puncture.
The causes of focal neurological conditions that should be considered include:
• Primary CNS lymphoma
• Infectious lesions: toxoplasmosis, cysticercosis.
If a mass lesion has been ruled out clinically (absence of raised intracranial pressure), a lumber puncture should be performed. Meningitis is a common syndrome amongst HIV positive persons and these are commonly due to bacterial and fungal causes.