Figure 4-10: Headache in Patients with AIDS

Figure 4-10: Headache in Patients with AIDS. Flow diagram with “Headache” as the starting box offering three alternative paths. Left main path begins with “Focal signs, seizure, or altered mental status” which leads to “MRI or CT scan with contrast” then “See next algorithm” (Center main path). Center main path starts with “No focal signs, CD4 >200, No meningismus” then has two branches. Left branch begins with “Fever: Evaluation for sinusitis (nasal symptoms and face pain) and systemic infection (see FUO algorithm)” then splits into two paths. Left path is “Diagnosis established” then “Treat” (algorithm endpoint). Right path is “No diagnosis and symptoms persist” then “CT scan or MRI and/or lumbar puncture” then “See next algorithm” (Right main path). Returning to “No focal signs, CD4 >200, No meningismus” (start of Center main path), right branch leads to “Afebrile: Evaluate for sinusitis (nasal symptoms and face pain), anemia, and primary causes of headache (tention, migraine, cluster, etc.)” then splits. Left path joins Right path at “No diagnosis and symptoms persist” (see previous). Right path is “Diagnosis established” then “Treat” (algorithm endpoint). Returning to the initial “Headache” box, Right main path begins with “Fever and/or meningismus without focal neurologic signs” then moves to “Serum cryptococcal antigen and VDRL ± lumbar puncture: cell count, protein, glucose, VDRL, AFB smear and culture, cryptococcal antigen ± cytology.” The flow then leads to four options. First option is “Cryptococcal antigen pos” then “Treat” (algorithm endpoint). Second option is “Serum VDRL pos plus cell/protein or CSF VDRL” then “Treat” (algorithm endpoint). Third option is “(up arrow) Cells/protein plus any evidence of TB” then “Treat” (algorithm endpoint). Fourth option is “No diagnosis and symptoms persist or progress” then leads back to Center main path “CT scan or MRI and/or lumbar puncture.”
Source: Bartlett, 2001. Reprinted with permission.