以神经精神症状为首发表现的人类获得性免疫缺陷综合征23例临床分析

目的 探讨23例以神经精神症状为首发表现的人类获得性免疫缺陷综合征(AIDS)的临床特征.方法 回顾性分析23例以神经精神症状为首发表现的AIDS临床资料.结果 23例中以中枢神经系统感染发病最常见(18例),其中新型隐球菌性脑膜炎7例,结核性脑膜炎4例,化脓性脑膜炎4例,病毒性脑炎3例;其次为HIV相关性痴呆综合征和急性脑梗死(各2例);罕见为HIV相关性急性多发性神经根炎1例.临床表现颇具多样性,首发症状缺乏特异性,首诊误诊率为100%.结论 以神经精神症状为首发表现的AIDS临床并非少见,表现复杂多样,容易误诊为神经精神疾病而延误诊治.     

以中枢神经系统症状为首发的AIDS患者临床误诊分析

目的探讨11例以中枢神经系统症状为首发的人类获得性免疫缺陷综合征(AIDS)患者的临床特征。方法回顾分析11例以中枢神经系统症状为首发的人类获得性免疫缺陷综合征患者的临床资料。结果 11例患者门诊以中枢神经系统感染6例,其中结核性脑膜炎3例,病毒性脑膜炎2例,化脓性脑膜炎1例,其次急性脑梗死2例;多发性脑梗死合并痴呆2例;慢性酒精中毒性脑病1例,门诊均误诊。结论以中枢神经系统症状为首发的AIDS临床并非少见,临床表现复杂多样,且容易误诊神经系统原发疾病而延误诊治。     

系统性红斑狼疮合并中枢神经系统感染34例临床分析

目的研究分析系统性红斑狼疮(SLE)合并中枢神经系统感染的临床表现。方法回顾性分析2001年1月至2011年12月石家庄平安医院34例SLE合并中枢神经系统感染患者临床资料,提出临床特征及其相关危险因素。结果 34例SLE合并中枢神经系统感染,发生率为1.44%;其中结核性脑膜炎25例(73.53%),新型隐球菌脑膜炎7例(20.59%),病毒性脑膜炎2例(5.88%)。给予内科常规治疗,25例结核性脑膜炎痊愈21例,死亡4例;7例隐球菌脑膜炎痊愈3例,死亡4例。病毒性脑膜炎痊愈1例,死亡1例。本文SLE合并中枢神经系统感染34例中总共死亡9例(26.47%)。全部患者在诊断前均经过糖皮质激素治疗,28例患者应用较大剂量激素治疗,18例患者联合免疫抑制剂治疗。SLE合并中枢神经系统感染的临床特点主要为高热、头痛及意识障碍;狼疮活动度评分(SLEDAI)平均9±3分。脑脊液检查发现糖和氯化物降低明显。结论①系统性红斑狼疮合并中枢神经系统感染以结核性脑膜炎最常见;②肾上腺皮质激素、免疫抑制剂的应用是SLE合并感染的危险因素;③SLE合并中枢神经系统感染与狼疮活动度无关,而神经精神狼疮多发生于狼疮高度活动期,SLEDAI评分对二者鉴别诊断有意义;④狼疮合并中枢神经系统感染以高热、头痛及颅内压增高为主要表现,反复腰穿脑脊液检查对SLE合并中枢神经系统感染的诊断和判断预后有重要价值。     

以中枢神经系统症状为首发表现的AIDS

目的探讨以中枢神经系统症状为首发表现的AIDS的临床特征及预后,提高对这部分患者的诊断识别能力。方法连续选择云南省德宏州盈江县人民医院的AIDS住院患者共165例,并对其中以中枢神经系统症状为首发表现的32例患者的临床资料进行回顾性分析。结果 32例患者中AIDS痴呆综合征10例,结核性脑膜炎4例,隐球菌脑膜炎5例,脑弓形虫病11例,蛛网膜下腔出血1例,脊髓损伤但性质未明确者1例。本组32例患者中1年内死亡的有26例,占81.2%。结论以中枢神经系统症状为首发表现的AIDS患者病情复杂,多合并中枢神经系统机会性感染,且进展快,预后差,死亡率高。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

结核性脑膜炎所致精神障碍的临床特点

目的探讨新疆结核性脑膜炎所致精神障碍的临床特点。方法选取2010-07—2014-06收治的90例结核性脑膜炎所致精神障碍患者为研究对象,总结患者的前驱症状、神经系统检查结果、精神障碍表现,并进行回顾性分析。结果所有患者入院前1~14d均存在多种精神障碍前驱症状,最常见是头痛、头晕和失眠,差异均有统计学意义(P0.05);90例患者中,脑CT异常90例(100.00%),脑电图异常80例(88.89%),明显高于心电图异常和电解质紊乱(P0.05),结核性脑膜炎所致精神障碍患者大多有脑CT和脑电图异常,精神障碍最常见的是谵妄和精神恍惚,明显高于其余两种表现(P0.05)。结论及时发现结核性脑膜炎导致的精神障碍的前驱症状并给予相应的神经系统检查和神经活动评估,在结核性脑膜炎的诊断过程中有重要意义。     

以共济失调为首发症状的艾滋病1例报告并文献复习

<正>艾滋病又称为获得性免疫缺陷综合症(acquired immunodeficiency syndrome,AIDS),是由人类免疫缺陷病毒(human immunodeficiency virus,HIV)引起的一种严重传染病。由于HIV具有亲淋巴性和神经性双重特征,HIV不仅破坏免疫系统,而且也损害神经系统。文献报道70%~80%的AIDS患者有神经系统病变,其中7%~20%患者表现为以神经症状首发[1-2],临床表现形式多样,但是以共济失调为首发症状的仅见个别报道[3]。本文现报告1例2015年11月首都医科大学     

31例艾滋病合并隐球菌脑膜炎临床分析

目的 :分析艾滋病合并隐球菌性脑膜炎的临床特点 ,治疗方法及预后。方法 :作者在援非医疗队期间中非友谊医院于 1998年8月～ 2 0 0 0年 12月收治的 3 1例HIV合并隐球菌性脑膜炎进行回顾性研究。结果 :HIV合并隐球菌性脑膜炎的临床表现以头痛、高热最为常见 ,脑脊液检查 ,墨汁染色见新型隐球菌 2 6例 (83 9% ) ,隐球菌多糖荚膜抗原 (ELISA法 )阳性 2 9例 (93 5 % )。治疗采用两性霉素B与 5氟胞嘧啶 (5 FC)或与咪唑类药联合治疗。结论 :讨论了HIV合并隐球菌性脑膜炎的临床表现 ,预后不良     

艾滋病合并中枢神经系统病变的诊断和临床特点分析

目的分析艾滋病合并中枢神经系统病变的诊断和临床特点。方法对2000—2011年住院治疗的320例艾滋病合并中枢神经系统病变的临床资料进行回顾性总结。结果 3 401例艾滋病患者中,合并中枢神经系统病变320例,发病率9.41%。其中新型隐球菌脑炎104例,原因不明的中枢神经系统感染72例,弓形虫脑炎33例,结核性脑膜炎29例,HIV相关脑病35例,脑白质病变19例,脑梗死16例,不明原因占位12例。T细胞亚群检测254例:CD4<50/mm3125例,CD4 50～100/mm356例,CD4 100～200/mm3 41例,CD4>200/mm3 32例,平均为86.79/mm3。320例中181例好转出院,68例治疗无效自动出院,死亡61例。结论 AIDS患者合并中枢神经系统病变发病率高,表现复杂多样,以CD4<100/mm3最为常见,临床诊断困难,病死率高,早期经验性治疗有助于诊断,改善预后。     

艾滋病合并中枢神经系统病变163例分析

目的探讨艾滋病患者中枢神经系统病变的临床特点。方法回顾分析我院2008-2010年收治艾滋病合并中枢神经系统病变163例患者临床资料。结果 1 763例艾滋病患者中,合并中枢神经系统病变163例,发病率9.25%。其中合并隐球菌脑膜(脑)炎50例(30.67%),原因不明的中枢神经系统感染33例(20.25%),结核性脑膜(脑)炎19例(11.66%),弓形虫脑炎19例(11.66%),HIV相关性脑病14例(8.59%),脑梗死6例(3.68%),脑白质病变6例(3.68%)。131例患者CD4+淋巴细胞<200/mm3。80例好转出院,31例自动出院,住院期间死亡14例。结论中枢神经系统病变仍是艾滋病患者常见的并发症,病情重,病死率高。在临床中应提高警惕,早诊断,及时治疗可以改善艾滋病患者的预后。     

Pathology of the central nervous system in patients infected with the human immunodeficiency virus (HIV): a Report of 252 autopsy cases from Brazil

The central nervous system (CNS) was studied in 252 HIV-infected patients from the States of Rio de Janeiro and Sgo Paulo in Brazil, the regions with the highest incidence of AIDS in the country. We compared the frequency and morphology of opportunistic infections and CNS changes caused by the HIV, with those described in other series and briefly analysed the risk factors involved in our cases. There were CNS lesions in 230 cases (91.3%), 30 (11.9%) with multiple infections and/or turnours. Most infections were opportunistic (65.4%), including 15.4% viral and 50% bacterial, fungal or protozoal infections. The most frequent was toxoplas-mosis (34.1%), followed by cryptococcosis (13.5%), cytomegalovirus (CMV) infection (7.9%) and nodular encephalitis (6.7%). Primary lymphomas were observed in 4% of the cases and HIV encephalitis or leukoencephalopathy in 10.7%. Other opportunistic and HW associated lesions were present in a limited number of cases and there were also vascular and non-specific lesions. Our study confirms the high frequency of CNS lesions in HIV infected patients. They are morphologically similar to those previously described. However, the higher incidence of toxoplasmosis and cryptococcosis, a lower incidence of viral opportunistic and HIV-associated lesions, and the presence of rarer lesions such as histoplasmosis and chagasic encephalitis, differ from other series, and may reflect geographical and/or socio-economic factors.     

Central nervous system infections in individuals with HIV-1 infection

Opportunistic infections of the central nervous system (CNS) are common complications of advanced immunodeficiency in individuals with human immunodeficiency virus type 1 (HIV-1) infection. Neurological disease is the first manifestation of acquired immunodeficiency syndrome (AIDS) in 10% to 20% of symptomatic HIV-1 infection. Prompt diagnosis and treatment of such disorders is critical. Also, in the era of highly active antiretroviral therapy (HAART), these disease states have changed in presentation and epidemiology. Therefore, we review the epidemiology, pathogenesis, clinical features, diagnosis, and management of five common central nervous system disorders in individuals with HIV-1 infection: toxoplasma encephalitis, primary central nervous system lymphoma, cryptococcal meningitis, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy.     

HIV-associated primary CNS lymorbidity and utility of brain biopsy

INTRODUCTION: Human immunodeficiency virus (HIV) infection is associated with several central nervous system (CNS) infections and neoplasms. These opportunistic processes generally occur with advanced immunosuppression, but if an accurate diagnosis is made, effective treatment can frequently be initiated. METHODS: In an attempt to assess the safety, diagnostic yield, and utility of stereotactic brain biopsy in the clinical management of suspected HIV-associated primary CNS lymphoma, we retrospectively studied the performance of biopsy in HIV-seropositive patients presenting with focal intracranial lesions. This analysis included 435 patients undergoing brain biopsy, identified through a local case series (n=47) combined with all published cases (n=388). The years of analysis for this study were 1984 and 1997. We also assessed the survival of HIV-associated intracranial mass lesions and of PCNSL patients treated at JHU. RESULTS: Definitive histopathological diagnoses were established in eighty-eight percent of biopsied cases: primary CNS lymphoma (PCNSL) (30%), CNS toxoplasmosis (CNS TOXO) (16%), progressive multifocal leukoencephalopathy (PML) (25%), and other specific diagnoses (17%). Post-biopsy morbidity within thirty days was 8.4% and mortality was 2.9%. PCNSL was the most common diagnosis among cases biopsied after failure of anti-toxoplasmosis therapy, 134/205 (65%). In the local case series, biopsy-related morbidity was associated with poor functional status, decreased platelet count, and number of lesions at presentation. The median survival of irradiated PCNSL cases was 29 days longer than untreated cases (median survival 50 days versus 21 days, respectively, Chi-square=6.73, P<0.01). DISCUSSION: Stereotactic brain biopsy had a high diagnostic yield for HIV-associated focal intracranial lesions, however, the biopsy complication rate in this patient population was relatively high. PCNSL was diagnosed in the majority of patients failing anti-toxoplasmosis therapy. Survival after irradiation for PCNSL remains very poor.     

Incidence of varicella zoster virus infections of the central nervous system in the elderly: a large tertiary hospital-based series (2007–2014)

The aim of the study was to describe the clinical and epidemiological characteristics of the central nervous system (CNS) infection by varicella zoster virus (VZV) in patients older than 65 years in a tertiary community hospital. We retrospectively analysed the results of cerebrospinal fluid (CSF) testing in patients older than 65 years between 2007 and 2014 with clinically suspected VZV infection with CNS involvement. Patients whose CSF samples were positive for VZV DNA were included, as were those with negative results who simultaneously presented herpes zoster and CSF or magnetic resonance imaging findings suggestive of CNS infection, and in whom other possible aetiologies had been ruled out. The study included 280 patients. The disease was considered to be caused by a VZV infection in 32 patients (11.4%), of which 23 cases were virologically confirmed (detection of VZV DNA in CSF). The most frequent diagnosis of the patients with VZV CNS infection was encephalitis (83.3%), followed by meningitis (13.3%) and cerebellitis (3.3%). The mean annual incidence of VZV CNS infection was 3.0 cases per 100,000 inhabitants. VZV was the most common cause of encephalitis and viral meningitis, ahead of herpes simplex virus (n = 9). At the time of discharge, 12 (40%) patients showed neurological sequelae. Five patients (20%) died during hospitalization, all with encephalitis. Patients with a fatal outcome had significantly higher median age and longer delay before initiating acyclovir. In conclusion, VZV was the first cause of encephalitis in our elderly population. Despite acyclovir treatment, there was a high rate of case fatality and sequelae at discharge.     

Increased activity of matrix metalloproteinases in the cerebrospinal fluid of patients with HIV-associated neurological diseases

Matrix metalloproteinases (MMPs) have been identified as mediators of brain injury in HIV-associated neurological diseases. The activity of the 72 kDa gelatinase A (MMP-2) and 92 kDa gelatinase B (MMP-9) was detected by zymography in the cerebrospinal fluid (CSF) of 138 HIV-infected patients (40 with AIDS dementia, 83 with brain opportunistic infections and 15 neurologically asymptomatic), 26 HIV-seronegative individuals with inflammatory neurological diseases (IND) and 12 HIV-seronegative subjects with noninflammatory neurological diseases (NIND). MMP-2 was present in all CSF samples from HIV-seropositive and HIV-seronegative individuals, including those of subjects with NIND. On the contrary, MMP-9 was absent in the CSF of NIND controls, whereas the activity of this MMP was found in the 77 - 100% of CSF samples from HIV-infected patients, including those with HIV dementia, central nervous system (CNS) opportunistic infections or neurologically asymptomatic subjects. The highest levels of MMP-9 were found in the CSF of patients with cryptococcosis, cytomegalovirus encephalitis and tuberculous meningitis and were comparable with those found in the CSF of HIV-negative patients with multiple sclerosis or meningitis. A significant correlation between CSF MMP-9 activity and CSF cell count was found only in patients with HIV dementia. The increased CSF activity of MMPs capable to degrade components of the extracellular matrix of blood-brain barrier may contribute to the transendothelial migration of virus-infected cells into the CNS and development of HIV-associated neurologic damage.     

Cases of temporal lobe epilepsy following mild encephalitis/meningitis or suspicion of these diseases

There are unexpectedly many patients with temporal lobe epilepsy (TLE) who previously experienced episodes of coma, high fever, and convulsion in childhood but were not diagnosed with encephalitis/meningitis. As these cases generally do not show obvious neurologic residua and mental retardation, the subsequent appearance of TLE is usually not ascribed to the episodes. Among 74 patients who underwent temporal lobectomy in Tokyo Metropolitan Neurological Hospital, we investigated the clinical findings, pathology, and imaging in 20 patients who had experienced childhood episodes of this type with or without diagnosis of encephalitis/meningitis. Seven patients were diagnosed with encephalitis, 10 were not diagnosed with encephalitis/meningitis, and three patients experienced seizures after vaccination. The incidence of anamnesis (27%) was higher than the previously reported incidence of central nervous system (CNS) infections (2.7%∼6.7%). A mild encephalitis/meningitis might comprise a more likely cause of TLE. Mild hemipareses appeared in eight patients after the episode, and subsequently disappeared in three of the eight patients. These episodes appeared before the age of 3 years in 75% of the cases. As the incidence of meningeal inflammatory findings on pathology (20%) was unexpectedly low, it can be presumed either that inflammatory findings disappear for a long clinical course or that there were no focal regions in the resected tissues. Hemispheral atrophy on magnetic resonance imaging (MRI) was found in 59% of the cases. Mild CNS infections are considered to be more important in the development of TLE and should be investigated in the future.     

Neuro-Intensive Care of Patients with Acute CNS Infections

Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.     

The incidence and aetiology of central nervous system infections in Helsinki in 1980

The aetiology of central nervous system infections was surveyed in a study at Aurora Hospital, Helsinki, in 1980. Of the 146 patients with central nervous system infections, 113 had aseptic meningitis, 23 bacterial and one tuberculous meningitis, and nine meningoencephalitis or encephalitis. The probable aetiology of aseptic meningitis was established in 67% of the 106 patients properly tested, the commonest agents being mumps (27%), Coxsackie (24%) and ECHO (9%) viruses. Haemophilus influenza type b was the most frequent cause of bacterial meningitis (39%), occurring solely among infants and young children. There were no cases due to Neisseria meningitidis group A, which used earlier to be epidemic in Finland. The incidences of aseptic, bacterial and tuberculous meningitis in Helsinki in 1980 (based on a total of 174 patients treated in the three hospitals admitting patients with central nervous system infections) were 26.7, 5.2 and 0.2 cases per 100,000 annually, and those of encephalitides and myelitis 3.5 and 0.6 cases per 100,000 annually.     

Neuropathology and general autopsy findings in AIDS during the last 15 years

A retrospective study of 450 consecutive AIDS autopsy cases (397 males, 53 females; mean age at death 38.4 years) in Vienna, Austria, between 1984 and 1999 compares the central nervous system (CNS) findings in three cohorts: 1984–1992 (190 cases), 1993–1995 (162 cases) and 1996–1999 (98 cases, after introduction of triple antiretroviral therapy) and the relationship of CNS findings to systemic AIDS pathology in the latter two cohorts. In these two groups, following involvement of the lung (85% and 75%, respectively), the brain continued to be the second most frequently involved organ (decrease from 80% to 60%, respectively). Extracerebral protozoal (Pneumocystis carinii, toxoplasmosis), Mycobacterium avium complex, viral [e.g., cytomegalovirus (CMV)], multiple opportunistic organ and CNS infections, and Kaposi sarcoma significantly decreased over time. There was less decrease in fungal infections, while bacterial organ and CNS infections (except for mycobacteriosis), lymphomas, HIV-associated CNS lesions (around 30%), non HIV-associated changes (vascular, metabolic, etc.) and negative CNS findings (10–11%) remained unchanged. Nonspecific CNS changes (e.g., meningeal fibrosis) increased. Extracerebral pathology in subjects with advanced HIV-related CNS lesions showed more frequent but decreasing systemic bacterial and CMV infections than those with negative or nonspecific neuropathology, while other opportunistic and multiple organ infections and lymphomas showed no differences between both groups. In a cohort of drug abusers, HIV encephalitis, progressive multifocal leukoencephalopathy, bacterial infections, hepatic encephalopathy, and negative CNS findings were more frequent than in non-users who showed increased incidence of CMV, toxoplasmosis, or other opportunistic CNS infections, and nonspecific CNS findings; the frequency of lymphomas was similar in both drug abusers and non-users. Similar to a recent autopsy study from San Diego, these data suggest that despite the beneficial effects of modern antiretroviral combination therapy, involvement of the brain in AIDS subjects continues to be a frequent autopsy finding, while the increased incidence of HIV encephalitis in our small cohort of drug users was less than observed in other recent autopsy studies. Received: 7 March 2000 / Revised, accepted: 24 March 2000