OPHTHALMOPLEGIA ASSOCIATED WITH AIDS

A 34-year-old man with AIDS was admitted to the hospital with a one-we ek history of cough, chest pain, and fever. Radiography revealed a cav itating left upper lobe lesion. Two weeks later he developed a headach e associated with a contrast enhancing lesion in the right parietal lo be. The patient had a progressive downhill course, developing atrioven tricular block and hypernatremia. Neuro-ophthalmologically, there was a mild facial droop, ''hand motions'' vision with presumed bilateral c ytomegalic inclusion retinitis, and signs of a mesencephalic syndrome, including lid retraction. Discussions center on the differential diag nosis of the central nervous system disease and the obligative recomme ndations the neuro-ophthalmologist must be willing to make.