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1.  Controversies in HIV-associated neurocognitive disorders 
The Lancet. Neurology  2014;13(11):1139-1151.
Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral drugs. However, prevalence estimates vary depending on the population and methods used to assess cognitive impairment. Whether asymptomatic patients would benefit from routine screening for cognitive difficulties is unclear and the appropriate screening method and subsequent management is the subject of debate. In some patients, HIV-1 RNA can be found at higher concentrations in CSF than in blood, which potentially results from the poor distribution of antiretroviral drugs into the CNS. However, the clinical relevance of so-called CSF viral escape is not well understood. The extent to which antiretroviral drug distribution and toxicity in the CNS affect clinical decision making is also debated.
doi:10.1016/S1474-4422(14)70137-1
PMCID: PMC4313542  PMID: 25316020
2.  Suboptimal management of central nervous system infections in children: a multi-centre retrospective study 
BMC Pediatrics  2012;12:145.
Objective
We aimed to audit the regional management of central nervous system (CNS) infection in children.
Methods
The study was undertaken in five district general hospitals and one tertiary paediatric hospital in the Mersey region of the UK. Children admitted to hospital with a suspected CNS infection over a three month period were identified. Children were aged between 4 weeks and 16 years old. Details were recorded from the case notes and electronic records. We measured the appropriateness of management pathways as outlined by national and local guidelines.
Results
Sixty-five children were identified with a median age of 6 months (range 1 month to 15 years). Ten had a CNS infection: 4 aseptic meningitis, 3 purulent meningitis, 3 encephalitis [2 with herpes simplex virus (HSV) type 1]. A lumbar puncture (LP) was attempted in 50 (77%) cases but only 43 had cerebrospinal fluid (CSF) available for analysis. Of these 24 (57%) had a complete standard set of tests performed. Fifty eight (89%) received a third generation cephalosporin. Seventeen (26%) also received aciclovir with no obvious indication in 9 (53%). Only 11 (65%) of those receiving aciclovir had CSF herpes virus PCR. Seventeen had cranial imaging and it was the first management step in 14. Treatment lengths of both antibiotics and aciclovir were highly variable: one child with HSV encephalitis was only treated with aciclovir for 7 days.
Conclusions
The clinical management of children with suspected CNS infections across the Mersey region is heterogeneous and often sub-optimal, particularly for the investigation and treatment of viral encephalitis. National guidelines for the management of viral encephalitis are needed.
doi:10.1186/1471-2431-12-145
PMCID: PMC3443041  PMID: 22958329
Encephalitis; Meningitis; Central nervous system infection; Aciclovir; Lumbar puncture
3.  Test them all; an easily diagnosed and readily treatable cause of dementia with life-threatening consequences if missed 
Practical Neurology  2013;13(6):354-356.
doi:10.1136/practneurol-2013-000689
PMCID: PMC3841794  PMID: 24222696
AIDS; COGNITION; INFECTIOUS DISEASES; MEMORY

Results 1-3 (3)