If the patient does not get better, the doctors may need to remove a small sample of brain or nerve tissue for examination to look further for the cause or causes of the symptoms. If doctors find an infection to be the cause of the neurologic symptoms, patients are given appropriate antibiotics, if available. Doctors use the drugs amphotericin B, sometimes combined with flucytosine, or fluconazole to fight cryptococcal brain infections. Pyrimethamine combined with sulfadiazine or clindamycin often is effective for toxoplasmic encephalitis. Following treatment for these conditions, patients must continue to take these medications to prevent a recurrence of the infection.
Doctors treat nerve inflammation caused by herpes zoster with the antiviral drug acy- clovir.
Doctors use AZT or ddI to treat patients with neurologic complications that appear to be caused by HIV itself, such as AIDS dementia complex. Radiation therapy may help patients with lymphoma or Kaposi's sarcoma that has spread to the brain or spinal cord. Treatment for peripheral neuropathy depends on the cause, site and extent of nerve damage. A number of different types of medications can be used, including AZT and gancyclovir, nonsteroidal anti-inflammatory drugs, as well as analgesics or antidepressants for pain. Patients may improve if they undergo plasmapheresis, a procedure in which blood plasma is removed and replaced by donor plasma.