In many cases, the treatments parallel those given for stroke in the non HIV-positive population. Given the young age of most HIV-positive patients, this is an infrequent occurrence. Occasionally, surgery may be indicated to evacuate intracerebral hematomas, clip an aneurysm, or remove an arteriovenous malformation. Once the acute medical management of the stroke has been completed, rehabilitation treatment should be initiated. Referral to a rehabilitation hospital, skilled nursing facility, or outpatient or home health therapist should be coordinated either by the neurologist or by a physical medicine consultant.
Activity depends on severity of the neurological deficit.
In HIV-positive patients, even more than in other patients with stroke, treating the underlying disease, both HIV itself and any intercurrent infections or neoplasms that may be responsible for the cerebrovascular event, is essential. Once the acute treatments are given and rehabilitation has begun, the neurologist should ensure that the patient has been placed on preventive treatments to reduce the risk of recurrent strokes. Prognosis in an HIV-positive patient with stroke is dependent on severity of the cerebrovascular event and stage of HIV infection. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurological complications of infection with human immunodeficiency virus type 1.