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June 14, 1995

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

Author Affiliations

Hôpital Bichat-Claude Bernard Paris, France

JAMA. 1995;273(22):1738. doi:10.1001/jama.1995.03520460020021

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In Reply.  —Dr Redosh believes that "neurological failure" is too imprecise and simplistic a term, given the complexity and diversity of neurological disturbances. This is indeed the case in a diagnostic setting, but not in the context of our prognostic study, which involved HIV-infected patients treated in an ICU. Our inclusion criteria were pragmatic and well suited to such patients in whom altered consciousness and convulsions are the two main neurological reasons for hospital admission. On admission to the ICU, altered consciousness was defined, regardless of the cause, as reduced consciousness requiring immediate intubation or likely to require intubation because of inability to handle airway secretions. In addition, recurrent convulsions or status epilepticus can necessitate emergent intubation and these were also included. We did not focus on patients with isolated neurological disorders (aphasia, hemiparesis, hemianopsia, and the like), who were not part of our cohort of patients admitted to the

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