CEREBROSPINAL-FLUID FERRITIN IN HIV-INFECTED PATIENTS WITH ACUTE NEUROLOGICAL EPISODES

Objectives: To measure cerebrospinal fluid (CSF) ferritin in HIV infec ted patients with acute neurological episodes and to correlate the fin dings with the type and severity of neurological disease. Methods: CSF ferritin and the ratio of CSF to serum albumin (QAlb) were prospectiv ely measured in 27 consecutive HIV infected patients admitted to a spe cialist unit for investigation of acute neurological episodes; the res ults were compared with their clinical diagnoses. Results: Ten patient s had HIV associated dementia complex, six had cryptococcal meningitis , two had primary CNS lymphoma and nine had miscellaneous conditions i ncluding herpes simplex virus encephalitis, cytomegalovirus encephalit is, cerebral toxoplasmosis and mononeuritis multiplex. Overall, 16 (59 %) patients had raised CSF ferritin levels, ranging from 13.0 to 50.2 mu g/l, (median = 16.1 mu g/l: normal range = 1.0-1.20 mu g/l). Thirte en of the 16 also had normal QAlb values, implying an intact CSF-blood barrier, and thus that local synthesis of ferritin had occurred. Elev ated ferritin levels were not associated with particular neurological diagnoses. In those with HIV associated dementia complex there was no correlation between CSF ferritin levels and the severity of clinical c ognitive deficit or the extent of magnetic resonance imaging abnormali ties. Conclusions: An elevated CSF ferritin level is a non-specific fm ding in HIV infected patients presenting with acute neurological episo des.