To the Editor.
—During the course of detailed serial examinations on 40 patients between the ages of 22 and 49 years with acquired immunodeficiency syndrome (AIDS)—related complex or AIDS as defined by criteria from the Centers for Disease Control, Atlanta (90% between the ages of 22 and 40 years), I have noted that prior to the development of early dementia at least one or more of the following tetrad is found to be present: glabellar or snout release signs, slowed saccadic eye movements, and difficulty repeating five numbers backward. Once even mild clinically apparent human immunodeficiency virus (HIV) dementia supervened, at least three of the four were present. Conversely, I have yet to observe a patient with none of this tetrad experience a cognitive problem of recent onset on an organic basis; these patients usually have a psychiatrically related disorder of mood or thought.The snout release sign was evaluated
Teschke RS. A Tetrad of Neurologic Signs Sensitive to Early Human Immunodeficiency Virus Brain Disease. Arch Neurol. 1987;44(7):693. doi:10.1001/archneur.1987.00520190009007
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