Some HIV-infected patients may have a history of seizure disorder prior to the HIV infection, so this should be asked about.
Causes of new-onset seizures in an HIV-infected patient:
(1) opportunistic infections (see below)
(2) primary HIV infection involving the brain (HIV encephalopathy)
(3) malignant lymphoma
(4) stroke
(5) intracerebral hemorrhage
(6) trauma
(7) alcohol abuse including withdrawal
(8) substance abuse
(9) drug adverse effect
(10) electrolyte abnormality (hyponatremia, hypomagnesemia, hypocalcemia)
(11) HIV dementia
(12) TTP
(13) other mass lesion
(14) aseptic meningitis
Opportunistic infections include:
(1) cytomegalovirus (CMV)
(2) Herpes simplex virus (HSV)
(3) Herpes zoster
(3) toxoplasmosis
(4) cryptococcosis
(5) histoplasmosis
(6) tuberculosis
(7) progressive multifocal leukoencephalopathy (PML)
(8) syphilis
(9) Nocardia
(10) cysticercosis
More than one cause may be present, especially when the CD4 count is low.
The cause of seizures may not be identified in some patients.
