艾滋病的神经系统特征

目的：国内艾滋病（AIDS）病例逐年增加，但神经科诊断的病例很少，分析艾滋病的神经系统特征以期提高诊断率。方法：回顾分析5例艾滋病患者的临床资料及脑脊液特征，结果：本组AIDS患者分别占同期神经科出院总人数、各种脑膜脑炎和隐球菌脑膜脑炎的0.55%、25%与100%，其病史及脑海脊液有其特征性。结论：艾滋病在神经科并非少见，对新型隐球菌脑膜炎等高危人群进行HIV筛查。     

艾滋病并发新型隐球菌脑膜炎临床分析

目的分析获得性免疫缺陷综合征（艾滋病）并发新型隐球菌脑膜炎的临床特点。方法腰椎穿刺术获得脑脊液,采用脑脊液乳胶凝集（LA）法检测新型隐球菌抗原。结果隐球菌脑膜炎是AIDS患者常见的中枢神经系统机会性感染,病死率高,易复发。结论早期诊断本病对提高治愈率、改善预后至关重要。     

脑积水为首发症状的艾滋病一例

患者男性,30岁。主因发热5d,头痛、腹痛、呕吐4d,于2010年11月4日入上海交通大学医学院附属第九人民医院奉城分院神经科治疗。     

腰大池和脑室外引流术在艾滋病合并隐球菌性脑膜炎患者颅内高压治疗中的应用

目的探讨腰大池和脑室外引流术对获得性免疫缺陷综合征(亦称艾滋病)合并隐球菌性脑膜炎患者颅内高压的治疗效果。方法共138例隐球菌性脑膜炎合并颅内高压患者[人类免疫缺陷病毒(HIV)阳性36例、HIV阴性102例],抗隐球菌治疗的同时,76例行腰大池引流术、改良腰大池引流术或脑室外引流术(HIV阳性17例、HIV阴性59例),62例行腰椎穿刺鞘内给药(HIV阳性19例、HIV阴性43例),比较引流组与鞘内给药组以及两组HIV阳性亚组与HIV阴性亚组患者引流管留置时间、脑脊液隐球菌培养转阴时间、并发症情况,并进行疗效评价。结果引流组患者治疗1周内颅内高压症状即明显改善。首次引流管置管中位时间30(17,35)d,其中HIV阳性者与HIV阴性者差异无统计学意义[28(15,32)d对30(18,35)d;U=-1.459,P=0.144]。引流组脑脊液隐球菌培养转阴中位时间41(26,58)d,其中HIV阳性者与HIV阴性者差异无统计学意义[46(28,66)d对36(21,45)d;U=-1.608,P=0.108];鞘内给药组脑脊液隐球菌培养转阴中位时间42(32,65)d,其中HIV阳性者与HIV阴性者差异无统计学意义[52(38,68)d对39(30,62)d;U=-0.401,P=0.688];而引流组与鞘内给药组差异有统计学意义(U=-2.117,P=0.034)。引流组治疗总有效率为86.84%(66/76),其中HIV阳性者与HIV阴性者差异无统计学意义[14/17对89.83%(53/59);χ~2=0.172,P=0.678];鞘内给药组为72.58%(45/62),其中HIV阳性者与HIV阴性者差异无统计学意义[8/19对86.05%(37/43);χ~2=0.023,P=0.880];而引流组与鞘内给药组差异有统计学意义(χ~2=4.413,P=0.036)。结论早期采用腰大池或脑室外引流术治疗艾滋病合并隐球菌性脑膜炎患者能够有效控制颅内高压、缩短有症状病程、提高临床疗效。     

艾滋病合并新型隐球菌脑膜炎56例临床分析

艾滋病（AIDS）即获得性免疫缺陷综合征，系感染人类免疫缺陷病毒（HIV）引起免疫系统功能进行性下降，易导致各种机会性感染。新型隐球菌脑膜炎是一种在AIDS患者中常见的致命性机会性感染。莱索托王国是艾滋病高发国家，发病率高达30％～40％。本文作者在莱索托医疗队援外期间收集整理了2005年9月~2007年7月在莱索托QueenⅡ医院内科病房HIV抗体阳性患者467例中确诊为新型隐球菌性脑膜炎56例的临床资料，现报道如下。     

艾滋病痴呆综合征临床分析

目的研究中国人群艾滋病(AIDS)痴呆综合征(ADC)的特征。方法对上海交通大学附属第一人民医院和上海市传染病医院收治的诊断为ADC的6例AIDS患者进行临床分析。结果所有患者均在清醒状态下表现为近记忆减退及注意力集中困难,其中3例伴有运动障碍。6例ADC患者中2例伴有空泡性脊髓病。诊断为AIDS后,ADC的平均诊断时间为6 5个月。所有患者均死于呼吸衰竭,平均寿命为41 8岁。结论ADC是AIDS患者最常见的神经系统并发症,常发生在AIDS的进展期。ADC通常伴有空泡性脊髓病,预后极差。     

新型隐球菌脑膜炎的临床分析

目的 分析新型隐球菌脑膜炎的临床及脑脊液改变特点。方法 对2例新型隐球菌脑膜炎进行回顾性分析。结果 2例病人均有发热、头痛、脑膜刺激征阳性。突出特点是颅内压力显著增高，脑脊液涂片墨汁染色1例在入院后首次检查发现新型隐球菌，另1例反复多次检查才发现新型隐球菌。死亡1例，痊愈1例。结论 新型隐球菌脑膜炎除脑膜炎的表现外，突出特点是颅内压力显著增高，脑脊液墨汁染色查见新型隐球菌是确诊的依据，但需多次检查才能发现新型隐球菌，导致诊断困难，不能及时抗真菌治疗，本病预后差，病死率高。     

脑脊液中新型隐球菌计数与预后的关系

目的 探讨在普通光镜下如何识别新型隐球菌及脑脊液中新型隐球菌数量与预后的关系。方法 在入院及治疗１月后各腰穿取脑脊液３～４ｍｌ,充入白细胞计数池内,观察隐球菌形态并计数。分析隐球菌数量动态变化与临床疗效的关系。结果 隐球菌与细胞在高倍镜下形态明显不同。２例首次脑脊液隐球菌数＞２００×１０６／Ｌ者,均恶化。脑脊液隐球菌数小于５０×１０６／Ｌ的３例患者全部治愈。治疗１月后４例隐球菌转为阴性者１例好转,３例痊愈;２例隐球菌数大于２００ ×１０６／Ｌ者,病情无好转。结论 脑脊液隐球菌数量与临床疗效及预后有关。     

以神经系统症状为首发表现的艾滋病4例报告及文献复习

艾滋病即获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS),是由人类免疫缺陷病毒(human immunodeficiency virus,HIV)引起的严重传染病,临床表现复杂多样。现将我院神经内科近3a收治的4例AIDS患者的临床资料结合文献复习如下。1病例资料病例1:男,41岁,江苏常州人,无业。因"反复发热2个     

以神经系统症状为首发的艾滋病3例报告

1　临床资料例 1 :患者男 ,2 9岁。因“持续头痛、头昏 2个月 ,加重 2周伴四肢抽动 1次”入院。曾在当地医院按“结核性脑膜炎”治疗 ,头颅 CT未见异常。近 1年体质差 ,体重减轻 5 kg。 2个月前患口腔真菌感染。查体 :口腔及舌表面可见白色假膜覆盖。项强 ,克 (氏 )征 (+)。入院后病情加重 ,表情淡漠 ,反应迟钝 ,视物模糊 ,烦躁、大喊大叫 ,注意力不集中。脑脊液检查 :内压 3 0 0 mm H2 O(2 9.4k Pa) ,细胞数 1 2 6× 1 0 6 / L,糖2 .8mmol/ L,氯 1 1 7.6mmol/ L,抗酸染色 (-) ,2次墨汁染色阳性。头颅 MRI未见异常。追问病史 ,其妻为人…     

Primary lymphoma of the brain associated with AIDS

Summary A typical case of acquired immune deficiency syndrome (AIDS) has been clinically and morphologically studied. This homosexual man whose past history was significant for i.v. drug abuse and sexually transmitted infection presented several opportunistic infections with a profound impairment of cellmediated immunity. Autopsy showed an intense lymphoid depletion, CMV-generalized infection, and a primary large cell immunoblastic lymphoma of the brain. The present case is discussed in the light of recent literature.Supported by a grant from FEGEFLUC (Fédération Nationale des Groupements des Entreprises Françaises dans la Lutte contre le Cancer — Marseille)     

Ischaemic myelopathy secondary to disseminated intravascular coagulation in AIDS

Summary A 39-year-old patient with AIDS presented with a rapidly progressive myelopathy with a partial Brown-Séquard syndrome. He died, 9 weeks after onset of the first neurological signs, from diffuse encephalopathy. Neuropathological examination revealed multiple, usually small, frequently haemorrhagic, infarcts or various ages and numerous fibrin thrombi in medium and small penetrating vessels and capillaries of the brain and spinal cord, characteristic of disseminated intravascular coagulation. There were no inflammatory changes. Immunohistochemical studies for human immunodeficiency virus, cytomegalovirus, varicella zoster virus, herpes simplex virus type 1 and type 2 were negative. Ischaemic spinal cord lesions due to disseminated intravascular coagulation may represent an unusual cause of focal, non-inflammatory, non-tumoral, myelopathic syndrome in AIDS.     

Loss of neurons in the frontal cortex in AIDS brains

Summary Neurons of Area 11 in the fronto-orbital cortex of 18 unselected AIDS brains are analyzed by means of stereology. Neurological abnormalities including dementing symptoms were described in eight patients. Neuropathology diagnosed human immunodeficiency virus (HIV)-specific changes in four, and diffuse poliodystrophy in eight brains. The majority (71.4%) of these brains was immunoreactive for HIV antigens when tested by immunocytochemistry. A significant loss of neurons is found as compared to normal controls. Neuronal density in AIDS brains is reduced by 18%, and the perikaryon volume fractions is reduced by 31%. Although only speculation on pathogenesis of this neuronal loss is possible at present, it may represent a part of the pathomorphological substrate of AIDS-related dementia. Moreover, it confirms by quantitative means damage to the cerebral cortex in AIDS which has been described only qualitatively as diffuse poliodystrophy.Supported by the Bundesministerium für Forschung und Technik (FKZ: II-040-87) of the Federal Republic of Germany, and by the Fonds zur Förderung der Wissenschaftlichen Forschung (P7154-MED) of Austria     

Cerebral atrophy in AIDS: a stereological study

Summary Stereological estimates of mean volumes, surface areas, and cortical thicknesses were obtained on formalin-fixed brains from 19 men with AIDS and 19 controls. Volumes of neocortex, white matter, central brain nuclei, ventricles and archicortex were estimated using point counting and Cavalieri's unbiased principle for volume estimation. In AIDS, the mean volume of neocortex was reduced by 11%, and that of the central brain nuclei by 18%. Mean ventricular volume was increased by 55%. Mean neocortical thickness was reduced by 12%. The mean volume of white matter was reduced by 13%. The findings in 6 clinically demented AIDS patients were not statistically different from the rest of the group.Supported by the Direktør Emil Hertz and wife Inger Hertz'Foundation, the Ferd. and Ellen Hindsgauls Foundation and Fonden for Neurologisk Forskning     

AIDS伴颅内占位性病变的立体定向活检术分析

目的 探讨立体定向活检术在获得性免疫缺陷综合征（AIDS）伴颅内占位性病变病人中的应用价值。方法 回顾性分析2017年8月至2021年12月收治的19例AIDS病人伴颅内占位性病变的临床资料,均行立体定向活检术取闹组织进行病理检查。结果 19例中,18例获得确诊,诊断阳性率为94.74%;其中真菌感染7例,肿瘤3例,进行性多病灶脑白质病、HIV脑病2例、结核肉芽肿各2例,弓形虫病、病毒性脑炎各1例。1例（5.26%）术后病理检查诊断不明确。术后出现穿刺道少量出血1例（5.26%）,无神经功能障碍,无手术死亡病例。根据活检术后病理结果给予相应治疗,随访4个月～1年,平均6个月,复查颅脑增强MRI显示15例病灶变小、数量减少和（或）周围水肿减少,好转率为78.95%;4例无明显变化。结论 AIDS病人伴发的颅内占位性病理性质多样,立体定向活检术能提供精准的诊断,并具有微创、安全的优点,可为治疗方案的制定提供有效的依据,提高临床治疗效果。     

Neuropathology of the acquired immune deficiency syndrome (AIDS): a report of 135 consecutive autopsy cases from Switzerland

Summary Neuropathological changes were studied in a consecutive autopsy series of 135 cases, comprising 73% of all patients who died of AIDS in Switzerland between April 1981 and December 1987. Central nervous system involvement was found in 119 patients (88%), 19 of which had multiple concomitant intracerebral lesions. Among the non-viral opportunistic infections, encephalitis due toToxoplasma gondii was most frequent and occurred in 35 patients (26%), followed by central nervous system infection withCryptococcus neoformans, which was found in five patients (4%). Cytomegalovirus (CMV) encephalitis was present in 14 patients (10%). Disseminated microglial nodules without morphological or immunocytochemical evidence of CMV was encountered in 18 patients (13%). However, in all but two of these patients there was evidence of extracerebral CMV infection, suggesting that CMV was responsible for these nodular encephalitides. Nine patients (7%) had progressive multifocal leukoencephalopathy (PML); in five of these, demyelination was associated with extensive tissue destruction and cyst formation. HIV-associated encephalopathy was observed in 21 patients (16%) and showed two characteristic morphological patterns: progressive diffuse leukoencephalopathy (PDL) and multifocal giant cell encephalitis (MGCE). PDL was observed in 13 cases and characterized by diffuse pallor and gliosis of the cerebral and cerebellar white matter with scattered multinucleated giant cells, but without significant inflammatory response. MGCE was found in eight patients and characterized by clusters of numerous multinucleated giant cells, rod cells, macrophages, lymphocytic infiltrates and occasional necroses. In our view, PDL and MGCE represent the two opposite variants of HIV-induced encephalopathies, with overlapping intermediate manifestations.     

Multinucleated giant cells in brain: A hallmark of the acquired immune deficiency syndrome (AIDS)

Summary Multinucleated giant cells (MGCs) were found in the brains of two patients with the acquired immune deficiency syndrome (AIDS), but were absent in five other AIDS brains. In one case there was a distinctive distribution of MGCs in disseminafed clusters; damage of brain parenchyma was minor or absent. In another case, MGCs were restricted largely to the perivascular spaces and were accompanied by lesions of toxoplasmosis and cytomegalovirus infection. In paraffin sections, morphological and histochemical-staining characteristics of MGCs were similar to those of macrophages. Occasional immunolabeling of MGCs with monoclonal antibody to leukocyte common antigen suggested a hematogenous origin. MGCs were not stained by immunocytochemistry for neural markers glial fibrillary acidic protein, S 100 protein, neurofilament proteins, neuron specific enolase, and myelin basic protein and, therefore, appear unlikely to originate from the neuroepithelium. In the absence of evidence of other infections in case 1, the peculiar tissue reaction found could be a direct result of infection by the AIDS retrovirus. The formation of MGCs is likely to represent a cytopathic effect of the virus on lymphoid or mono-histiocytic cells infiltrating the brain (infection of these cells could occur before or after they entered the brain). These assumptions are supported by the finding of similar MGCs in permissive lymphoid cell cultures after infection with the AIDS retrovirus.     

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.     

Leucoencephalopathy with multinucleated giant cells containing human immune deficiency virus-like particles and multiple opportunistic cerebral infections in one patient with AIDS

Summary A 29-year-old homosexual male with AIDS presented with progressive encephalopathy and cytomegalovirus (CMV) pneumonia. Neuropathological examination revealed toxoplasma abcesses in corpus callosum, basal ganglia and cerebellar white matter; demyelinating foci in the parietal white matter, with microscopic changes typical of progressive multifocal leucoencephalopathy and intranuclear papovavirus inclusions in oligodendrocytes; and lesions of subacute encephalitis in the periventricular regions with large cells positive by immunostaining for CMV. Diffuse myelin loss was observed in the cerebral white matter. Multinucleated giant cells were numerous in the demyelinated areas, they were also observed in close relationship with papova, CMV and Toxoplasma lesions. Immunostaining of these cells was positive for histiocyte markers and negative with the leucocyte common antigen monoclonal antibody. Some of them contained virus-like particles measuring around 100 nm similar to human immune deficiency virus (HIV) as observed in human brain.This paper was the subject of a preliminary communication at the 61st meeting of the British Neuropathological Society joint with le Club Français de Neuropathologie, Brighton, 10–11 July 1986     

艾滋病并发真菌性脑膜炎2例

目的:对艾滋病(AIDS)并发真菌性脑膜炎的流行病学、临床特点、诊断及治疗进行总结和分析。方法:报告2例AIDS并发真菌性脑膜炎的临床资料,并结合国内、外相关文献分析。结果:2例男性,主要表现头痛、发热、抽搐。脑脊液真菌培养1例为罗伦隐球菌,另1例为新型隐球菌。均予治疗,前者因脑疝住院期间死亡,后者病情稳定仍在随访中。HIV-1抗体均为阳性。结论:真菌性脑膜炎是AIDS患者常见的机会性感染,为AIDS的主要致死病因之一,需及时诊断治疗。