BIPLEDs with Complete and Rapid Recovery in a Patient with AIDS Encephalopathy

Abstract

ABSTRACT.A 33-year-old male with AIDS (CD4=12), dementia, spasticity, and MRI findings of cerebral atrophy and deep white matter changes was admitted for the treatment of chronic cough and cellulitis of the legs. Two days after admission, the patient exhibited the first seizure of his life—a generalized convulsion lasting five minutes. An EEG obtained 14 hours after the convulsion revealed bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) with prominent asynchrony. CT and MRI showed abnormalities similar to those present one year before. CSF studies obtained the day after the seizure were normal. The only medication started in the hospital prior to the onset of the seizure was intravenous nafcillin. Immediately after the seizure, nafcillin was discontinued and a loading dose of 1500 mg PE of fosphenytoin was given followed by oral maintenance. Another EEG, three days later, demonstrated the complete resolution of BIPLEDs. No other seizures occurred. With antibiotic therapy the cellulitis and pneumonia resolved and, within two weeks, the patient was discharged home on phenytoin. We propose that in patients with AIDS encephalopathy, the occurrence of coma, seizures, and BIPLEDs should not be assumed to be a poor prognostic sign.