Seizures occur in about 10% of HIV-infected patients, and some of these develop status epilepticus. Early and aggressive management may reduce morbidity and mortality associated with seizures.


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.


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