ObjectivesTo report the occurrence of a syndrome of recurrent neurological deficits in advanced HIV disease and to discuss its management and prognosis.DesignRetrospective case study.SettingA regional treatment centre for HIV-infected individuals in northwest England.Main outcome measuresTransient neurological deficit was defined as a focal neurological deficit of rapid onset which resolved completely within 24 h. Frequency, character and duration of episodes were recorded. Prior illnesses, CD4 count, changes in drug therapy and brain imaging investigations were also documented.ResultsSeven cases with recurrent transient neurological deficits were identified among 748 patients over a 10-year period. Six had a CD4 cell count <50×106/l. The episodes lasted between 1 and 12 h and resolved completely without lasting sequelae. Dysphasia and hemiparesis were the most common presentations. Recurrent episodes for each patient tended to follow a similar pattern. None had computed tomographic evidence of cerebral infarction or clinical evidence of completed stroke. Prognosis was varied and not evidently altered by the episodes of neurological deficit. Three patients may have benefited from treatment with migraine prophylactics.ConclusionA syndrome of recurrent transient neurological deficits may occur in advanced HIV disease. We believe that in some cases this may be due to local cerebral vasospasm, comparable to a classic migraine aura.