1. Case Study: Delirium in an Adolescent Girl With Human Immunodeficiency Virus- Associated Dementia Michelle Lisk

2. Background Info ► Female ► 15 years old ► History of HIV infection ► From the inner city of Baltimore

3. 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

4. ► The top row of images are of the patient ► The bottom row of images were taken of a normal 16-year- old

5. Damages ► Overall thinning of the corpus callosum ► Prominent ventricles and sulci ► Signal abnormalities were observed in the right caudate nucleus ► Extensive cerebral atrophy

6. Examination 3 Years Prior ► Preformed in the 93 rd 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 ► 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 Current Examination (After treating the episode of delirium)

7. 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

8. 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

9. 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?