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Neurological Letter from South Africa
  1. Roland Eastman
  1. Division of Neurology, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa; Email: reastman{at}



After two decades in the neurological trenches of a busy, developing world, general hospital, one hopes to have reached a state in which, by and large, one’s adversary is usually clinically recognizable. Rising to the challenge of making a diagnosis, and, often equally important, knowing what to suggest as the wisest course of action for each individual patient, is part of the job satisfaction. So it comes as something of a shock to find yourself robbed of certain clinical impressions that you may have comfortably harboured. For this is what happens when you come face-to-face with an epidemic in which the nervous system is involved in over 90% of the patients, and in which the neurological picture has a thousand faces. I refer to HIV/AIDS. In our hospital, the daily general medical ward intake of about 30 patients now contains about 40% with HIV

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