Clinical impact of cytomegalovirus infections of the nervous system in patients with AIDS.

Cytomegalovirus (CMV) causes five distinct neurological syndromes in patients with AIDS: retinitis, myelitis/polyradiculopathy, encephalitis with dementia, ventriculoencephalitis, and mononeuritis multiplex. The clinical syndromes associated with CMV ventriculoencephalitis and diffuse encephalitis in patients with AIDS have only recently been clearly described despite the fact that multiple neuropathologic descriptions of CMV in the brain have been published over the past decade. Even more-subtle levels of cognitive impairment have been detected in patients with CMV retinitis who are also at increased risk of developing diffuse CMV encephalitis. Demonstration of CMV DNA in the CSF with use of the polymerase chain reaction may provide both a sensitive and specific method for diagnosis of these syndromes. The effectiveness of aggressive early treatment of CMV syndromes in the nervous system, with the exception of retinitis, is unclear and warrants formal trials.