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June 14, 1995

Outcome of Patients With HIV Infection and Decreased Consciousness or Recurrent Seizures

Author Affiliations

Westminster, Colo

JAMA. 1995;273(22):1738. doi:10.1001/jama.1995.03520460020020

To the Editor.  —Dr Bédos and colleagues1 make a noble attempt to determine prognosis for neurological patients with human immunodeficiency virus (HIV) infection. However, I take issue with the term "neurological failure," which seems to imply that neurological failure can be defined as simply as congestive heart failure, renal failure, or liver failure. The nervous system is highly complex and physicians are sufficiently sophisticated with determining dysfunctions of individual subsystems of the nervous system. The term "neurological failure" is a misnomer.The authors have defined neurological failure as altered consciousness and/or convulsions requiring intensive care unit (ICU) management. Clearly, the patient who is comatose or stuporous with a profound encephalopathy would meet the definition. But what about a patient with a mild dementia who has a generalized tonic/clonic seizure with a prolonged postictal period, or a patient who is aphasic or develops a hemianopsia or hemiparesis? These lesions may

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