Síndrome de imunodeficiência adquirida: análise das complicações neurológicas em 44 casos

Abstract

We studied the clinical records of 280 patients admitted to our Hospital between 1985 and 1988, with a positive Elisa test for HIV-related antibodies: 15.71% (44) of these patients exhibited clinical abnormalities related to disease of the CNS. In 6 (13.6%) patients the neurological complication was the first manifestation of HIV-infection. Patients were mainly male homosexuals, in the 30-39 age range. Frequent chief complaints included hemiparesis, headache and behavior disturbances. Cerebral toxoplasmosis was diagnosed in 18 instances. It should be considered the first diagnostic possibility in patients presenting with mass lesions. Meningeal infections were present in 19 cases (cryptococcal in 13, tuberculous in 4, HIV-related in 2). CSF findings in these patients were non specific, except for demonstration of Cryptococcus neoformans on direct examination of CSF or culture studies. CT scans frequently displayed unique or multiple hypodense lesions. The lesions exhibited ring-enhancement in 7 instances, and were non-enhancing in 8 others. Cortical and subcortical atrophy with hydrocephalus ex-vacuum were occasionally found, and the CT scans were normal in 8 instances. Time from appearance of the various neurological complications to death or clinical resolution was almost always shorter than 6 months. Death was the most frequent outcome, usually occurring within 6 months. Survival in the most of these patients never reached the end of the first year.

Brain computed tomography of patients with HIV/AIDS before the advent of subsidized treatment program in Nigeria

“…In this study, brain mass lesion was seen in 11.1%. This finding agrees with the findings by other authors that brain mass lesions were seen in 10% of patient with HIV/AIDS 417–2628…”

“…This finding is consistent with reports by other authors 46141718. Twenty-four males (60%) were investigated with CT scan compared to 12 females (40%).…”

“…Other lesions recorded are shown in the table. These findings are consistent with the report of other authors that the main diagnoses to exclude in patient with HIV/AIDS which led to request for brain CT scans were stroke, tuberculosis, toxoplasmosis and lymphoma 46101718. Cerebral infarct-like lesions [Figure 3], presenting clinically as stroke, is recognized as one of the radiological findings of many CNS conditions in patients with AIDS who develop focal mass-like effect and ring-enhancing lesions 21–27.…”

“…In previous studies by several authors, central nervous system (CNS) complications were observed in 75% of patients with HIV/AIDS showing that this might be a leading cause of death. For patients with HIV/AIDS who were attending clinics for the first time, 25% presented neurological symptoms 461417…”

Neurological Manifestations of Acquired Immunodeficiency Syndrome

“…Nakagawa et al 1997, in Japan, reported 28.7% of MN in AIDS patients [ 7 ]. Puccioni et al in 1989 in Brazil, in a study similar to ours, found 15.71% of NM in young adults with less than a year of evolution of AIDS [ 8 ]. Another Brazilian study on inpatients reported 40% of NM in AIDS patients [ 9 ].…”