Progressive polyradiculopathy in acquired immune deficiency syndrome

We studied three patients with acquired immune deficiency syndrome (AIDS) and progressive polyradiculopathy. Postmortem examination of one patient disclosed extensive necrosis, inflammatory infiltrates, and focal vasculitis of spinal roots. Typical cytomegaloviral (CMV), intranuclear, and intracytoplasmic inclusions were noted within enlarged endoneurial and endothelial cells. Progressive polyradiculopathy is an unusual complication of AIDS; CMV may be the causative agent in certain cases.     

Progressive multifocal leukoencephalopathy in acquired immune deficiency syndrome

Progressive multifocal leukoencephalopathy occurred in two homosexual men affected with acquired immune deficiency syndrome (AIDS). Both patients received HLA-matched platelet transfusions in an attempt to increase their immune status, but we were unsuccessful in altering their fatal clinical course.     

Progressive multifocal leukoencephalopathy in a patient with acquired immune deficiency syndrome

Progressive multifocal leukoencephalopathy (PML) occurred in a heterosexual Haitian man with acquired immune deficiency syndrome (AIDS). The patient initially had focal neurologic signs and nonenhancing lesions on a computed tomographic scan. Although PML is rare, it should be included in the differential diagnosis of opportunistic infections associated with AIDS. Brain biopsy is suggested in patients suspected of having PML who might benefit from antiviral therapy.     

Spongiform encephalopathy in a patient with acquired immune deficiency syndrome (AIDS)

Summary The histological and ultrastructural findings of subacute spongiform encephalopathy (SSE) are described in the cerebral cortex and basal ganglia of a homosexual patient who died with acquired immune deficiency syndrome (AIDS). It is suggested that SSE, beside the diffuse AIDS leukoencephalopathy, might be another morphological substrate of the AIDS dementia complex.Supported in part by a scholarship from the Alexander von Humboldt Foundation (FC-S)     

Progressive multifocal leukoencephalopathy in a case of acquired immune deficiency syndrome

The case of a 40-year-old homosexual male with A.I.D.S. (Acquired Immune Deficiency Syndrome) and P.M.L. (Progressive Multifocal Leukoencephalopathy) is described. The importance of a brain biopsy for diagnostic procedures, especially in the case of a patient with A.I.D.S. is stressed. The diagnosis P.M.L. has been made by means of light- and electronic microscopical examination, and the presence of JCV-DNA in the brain tissue has been confirmed by dot hybridization. Various antiviral treatments did not show any effect on the course of the P.M.L.     

Progressive diffuse leukoencephalopathy in patients with acquired immune deficiency syndrome (AIDS)

Summary Two adult patients with acquired immune deficiency syndrome (AIDS) presented with psychoorganic symptoms produced by an extensive cerebral and cerebellar leukoencephalopathy. Diffuse loss of myelin and axons with reactive astrocytosis and distinctive multinucleated giant cells were prominent in the deep white matter, but less so in the subcortical white matter and in compact myelinated pathways. Bilateral involvement of the centrum semiovale produced distal Wallerian degeneration of the descending pyramidal tracts, which in one patient correlated with progressive paraparesis and bladder dysfunction. Although there were morphological indications of cytomegalovirus infection and immunohistochemical evidence of papovavirus antigens, the neuropathology did not resemble that usually associated with infection by these opportunistic agents. The possibility is entertained that the progressive diffuse leukoencephalopathy (PDL) in these patients was directly related to infection with human T-cell lymphotropic virus (HTLV-III/LAV), the etiologic agent of AIDS.     

Neurological complications in infants and children with acquired immune deficiency syndrome

Neurological complications occurred in 6 children, aged 6 months to 5 years, with acquired immune deficiency syndrome who were followed for 14 months. The most frequent manifestations included encephalopathies, acquired microcephaly, and pyramidal tract signs. Computed tomographic examinations showed variable degrees of cortical atrophy with ventricular dilatation and calcification. Electrophysiological abnormalities were demonstrated. Two children had documented central nervous system infections. Neurological deterioration resulted in dementia in 3 children. Cognitive impairment and developmental delays were evident in the other 3. Postmortem examination of the 3 children who died showed subacute cytomegalovirus encephalitis in 1; nonspecific hemispheric white matter changes, calcific vasopathy of the basal ganglia, and striking bilateral corticospinal tract degeneration in the second; and extensive calcific vasopathy of the basal ganglia and frontal centrum semiovale, and bilateral attenuation of the frontopontine and corticospinal tracts in the third.     

Progressive encephalopathy in a child with cerebral folate deficiency syndrome

Cerebral folate deficiency syndrome, a recently recognized cause of developmental delay, regression, and seizures, is associated with autoantibodies against folate receptors. A female child with developmental delay and a history of seizures who presented with seizures and unexplained coma is reported. Extensive testing to evaluate the patient's coma and subsequent developmental regression were unrevealing until the results of her cerebrospinal fluid neurotransmitter analysis returned. These showed low levels of methyltetrahydrofolate, the active metabolite of folate in the cerebrospinal fluid; subsequently, elevated titers of autoantibodies against folate receptors were found. Despite treatment with folinic acid, she developed intractable epilepsy and severe developmental delay.     

Wernicke's encephalopathy in acquired immune deficiency syndrome (AIDS): a case report

A 40-year-old male, with established AIDS developed cachexia and dementia. At autopsy opportunistic infections were found. An additional neuropathological finding was Wernicke's encephalopathy. Although malnutrition is common in AIDS patients, it seems that Wernicke's encephalopathy is rare in AIDS. Nevertheless, it is suggested that a therapeutic trial with parenteral thiamine may be useful in AIDS patients with amnestic syndrome and dementia.     

Neuroepidemiology of acquired immune deficiency syndrome

Neuroepidemiology is that branch of chronic disease epidemiology dealing with disorders that affect the nervous system. The potential for neurological involvement in the diagnosis and pathogenesis of Acquired Immune Deficiency Syndrome (AIDS) has recently been noted. The following review outlines the spectrum of neurological conditions seen in AIDS patients to date. These conditions include: infectious central nervous system complications of viral, bacterial, fungal or protozoan origin; noninfectious central nervous system complications such as neoplasms or cerebral vascular accidents, and cranial and peripheral neuropathy. The incidence of neurological abnormalities among AIDS cases may be seriously underestimated due to a delay in the presentation of an overt neurological syndrome and/or the overlooking of subtle neurological signs and symptoms in such an overwhelming systemic disease.     

Cytomegalovirus polyradiculoneuropathy in acquired immune deficiency syndrome

A 34-year-old homosexual man with acquired immune deficiency syndrome developed extraocular muscle deficits, chorioretinitis, and paraplegia without sensory symptoms. EMG showed severe diffuse denervation, but only mildly slowed nerve conduction velocities, in both legs. Meningitis persisted for 6 weeks and was exacerbated prior to the patient's death. Necropsy revealed subpial and subependymal cytomegalovirus (CMV) infection. Histology of ventral roots demonstrated proximal CMV infection and massive fiber loss. In this immunosuppressed patient, CMV caused a severe motor polyradiculopathy by selective destruction of the motor neurons of ventral spinal roots and motor cranial nerves.     

Progressive cytomegalovirus encephalopathy following congenital infection in an infant with acquired immunodeficiency syndrome

Congenital central nervous system infection with cytomegalovirus (CMV) usually results in a nonprogressive encephalopathy. Ninety percent of patients with clinically apparent infections at birth have a permanent neurological disability. It has been suggested that some infants may have persistent infection manifested by progressive encephalopathy during infancy. In the present case, clinical and pathological findings suggest the reactivation of a prior intrauterine CMV infection in a child with human T-lymphotrophic virus type III (HTLV-III) infection. The presence of HTLV-III may have reduced the immune surveillance of this infant, allowing the CMV to reactivate.     

Leptomeningeal lymphoma in a child with acquired immune deficiency syndrome

Primary non-Hodgkin lymphoma of the central nervous system is rare in pediatric AIDS patients. We report a seven-year-old HIV-infected boy, in stage C3 of the disease, who developed non-Hodgkin lymphoma in the central nervous system with a leptomeningeal location. The patient started with signs and symptoms of increased intracranial pressure, impaired consciousness and then became blind. The diagnosis was based on brain biopsy, immunophenotypic studies of B cells, and Epstein-Barr virus serology of the cerebrospinal fluid. The boy was treated with intrathecal and systemic chemotherapy. Fifteen months after diagnosis he had clinically improved, but he then relapsed with a thalamic tumor. He was treated with radiotherapy and he died four months later. In the present article, we discuss diagnostic difficulties, evolution, treatment, and the association of this neoplasm with the Epstein-Barr virus.     

Findings in psychiatric consultations with patients with acquired immune deficiency syndrome

Thirteen of 40 patients with acquired immune deficiency syndrome (AIDS) admitted to the wards of a large city hospital were seen by the staff of a psychiatric consultation service. Eleven were gay men and two were bisexual men. "Depression" was the stated reason for referral of 10 patients; of these, two met DSM-III criteria for major depression, one had dysthymic disorder, and seven had adjustment disorder with depressed mood. Recurrent psychological themes of the 13 patients were: dealing with a life-threatening illness, uncertainty about the implications of an AIDS diagnosis, social isolation, and guilt over their previous life style. The role of the primary physician and of the mental health professional in the psychological care of AIDS patients is discussed.     

Cerebral toxoplasmosis in the acquired immune deficiency syndrome

We examined the clinical and pathological features of 26 patients who presented with a diagnosis of CNS toxoplasmosis. Patient data was analyzed with respect to demographics, clinical presentation, treatment course and pathology. Patients presented with a wide variety of signs and symptoms. All patients had positive serum antitoxoplasma IgG; ring enhancing lesion(s) were present on all but one brain CT scans. A series of guidelines in the management of CNS toxoplasmosis in AIDS patients are presented. Prior to biopsy, patients with positive serology and characteristic CT scans should receive two weeks of treatment. Biopsy is indicated in those cases with negative serology, atypical presentation, progressive clinical deterioration, or differential response of lesions to empiric therapy.     

Myopathy complicating the acquired immune deficiency syndrome

A case of Acquired Immunodeficiency Syndrome complicated by a severe myopathy is reported. All efforts aimed at documenting an infectious etiology for the myopathy were negative. The relationship of myopathy to AIDS is discussed.     

Hemichorea-hemiballismus associated with acquired immune deficiency syndrome and cerebral toxoplasmosis

A young woman had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection complicating human immunodeficiency virus infection. This patient had the sixth reported case of acquired immune deficiency syndrome (AIDS) with hemichorea-hemiballismus, and each has been secondary to cerebral toxoplasmosis. The presence of hemichorea-hemiballismus in a young patient should suggest a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Other movement disorders that occur in AIDS are discussed.