Transcript Case Study: Delirium in an Adolescent Girl With Human

Case Study: Delirium in an
Adolescent Girl With Human
Immunodeficiency VirusAssociated Dementia
Michelle Lisk
Background Info
► Female
► 15
years old
► History of HIV infection
► From the inner city of Baltimore
Problems
► HIV
virus in its late stages causes
development of HIV-associated dementia
(HAD)
► Fevers incited bouts of delirium due to her
current condition of HAD
► The
top row of
images are of
the patient
► The
bottom row
of images were
taken of a
normal 16-yearold
Damages
► Overall
thinning of the corpus callosum
► Prominent ventricles and sulci
► Signal abnormalities were observed in the
right caudate nucleus
► Extensive cerebral atrophy
Examination 3
Years Prior
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Preformed in the 93rd percentile
in adaptive behavior skills tests
Talkative and able to carry on
reciprocal conversation
No reported disruptions in
thinking, behavior or skills
Normal motor functioning,
posture and gait
Current
Examination
(After treating the episode of delirium)
►
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Vineland Adaptive Behavior
assessment showed patient to
be in the first percentile for
adaptive functioning
Could recall names of people
around her, but conversation
was empty and non-reciprocal.
Also exhibited speech latency
when responding to a question.
Easily agitated and physically
aggressive
Displayed resting tremors and a
decline in posture and gait
Discussion
► Severe
cognitive decline is most likely caused by
marked cerebral atrophy
► Damage to the right caudate nucleus could explain
the lack of response to the attempts to restrain
and calm the patient
► Lack of attention and inability to maintain
productive conversation is likely due to the
thinning of the corpus callosum
► Interestingly, the patient showed no deficits in IQ
knowledge as compared to earlier scores
suggesting her long-term memory was relatively in
tact
Outlook
► The
acute episode of delirium was treated on site
► HAD currently has no cure
► The best treatment for HAD is highly active
antiretroviral therapy to attempt to slow down the
process of atrophy
► Patient has currently discontinued treatment with
antiretroviral meds due to resistance
► Treatment with these types of medications is
problematic due to the interactions they have with
other drugs
Interesting Thoughts
► Patient
showed a severe decline in both
memory and cognition in a matter of three
years with no treatment for this continued
atrophy
► While the atrophy itself may not be halted,
are there any alternate treatments that
would stave off the cerebral decline?