The utility of clinical and radiographic features in the diagnosis of cytomegalovirus central nervous system disease in AIDS patients

Burke, Don; Leonard, Debra G.B.; Imperiale, Thomas F.; Valdez, Hernán; Karaman, Boris A.; Shick, Elizabeth; Kalayjian, Robert C.

doi:10.1016/s1084-8592(99)80048-4

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…Diffuse encephalitis is the most common of these and presents with fever, headache, and non-specific non-focal neurologic signs such as confusion and memory loss. Immunosuppressed patients are more likely to have focal neurologic signs [88,91,92]. Ventriculoencephalitis is particularly associated with a positive HIV status [88,91] and typically has a rapid onset with quick neurologic decline, usually to coma and death [88].…”

Section: Cytomegalovirusmentioning

confidence: 99%

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Neuroimaging of herpesvirus infections in children

2007

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Six members of the herpesvirus family cause well-described neurologic disease in children: herpes simplex virus-1 (HSV-1), herpes simplex virus-2 (HSV-2), varicella-zoster (VZV), Epstein-Barr (EBV), cytomegalovirus (CMV), and human herpes virus-6 (HHV-6). When herpesviruses infect the central nervous system (CNS), the clinical presentation is non-specific and often confounding. The clinical urgency is often underscored by progressive neurologic deficits, seizures, or even death, and prompt diagnosis and treatment rely heavily on neuroimaging. This review focuses on the spectrum of cerebral manifestations caused by these viruses, particularly on non-congenital presentations. Recent advances in our understanding of these viruses are discussed, including new polymerase chain reaction techniques that allow parallel detection, which has improved our recognition that the herpesviruses are neurotropic and involve the CNS more often than previously thought. Evolving knowledge has also better elucidated viral neuropathology, particularly the role of VZV vasculitis in the brain, HHV-6 in febrile seizures, and herpesvirus reactivation in immunosuppressed patients. The virology, clinical course, and CNS manifestations of each virus are reviewed, followed by descriptions of neuroimaging findings when these agents infect the brain. Characteristic but often subtle imaging findings are discussed, as well as technical pearls covering appropriate use of MRI and MRI adjuncts to help differentiate viral infection from mimics.

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Section: Cytomegalovirusmentioning

confidence: 99%

“…8). In patients with ventriculoencephalitis, there is also periventricular enhancement [88,91,98,99]. In 1990, Balakrishnan et al [97] documented decreased T1-W signal in these patients and explained that increased T2-W signal was obscured by adjacent CSF signal.…”

Section: Neuroimaging Findingsmentioning

confidence: 99%

Neuroimaging of herpesvirus infections in children

2007

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“…Positive detection of cytomegalovirus in cerebrospinal fluid and blood with PCR aids to confirm the diagnosis. 7,8 Our patient had the characteristic finding of far higher levels in the cerebrospinal fluid than blood. Cytomegalovirus can be cultured in up to 60% of cerebrospinal fluid samples.…”

Section: Discussionmentioning

confidence: 70%

“…In AIDS, polyradiculopathy can also occur due to other etiologies, including toxoplasmosis, syphilis, lymphoma, tuberculosis, cryptococcus, Varicella-Zoster virus, Epstein-Barr virus, and Herpessimplex virus. 7,8 Cerebrospinal fluid studies and spinal imaging are useful diagnostic aids in cytomegalovirus polyradiculopathy. Our patient had a mild, predominantly neutrophilic pleocytosis with an elevated protein and low glucose ratio that is typical of cytomegalovirus polyradiculopathy in the immunocompromised host.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Cytomegalovirus Polyradiculopathy in a 9-year-old Child With Congenital Human Immunodeficiency Virus Infection

et al. 2009

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Cytomegalovirus lumbosacral polyradiculopathy is a well-documented complication of human immunodeficiency virus in adults who have a CD4 count of less than 40/microL. Patients present with an acute ascending flaccid paralysis of the lower limbs with areflexia, paresthesia, and urinary and bowel symptoms. However, it appears to be rare in children with congenitally acquired immune deficiency syndrome. We report a 9-year-old child with congenital human immunodeficiency virus infection who presented with cytomegalovirus polyradiculopathy and made an excellent response to cytomegalovirus treatment.

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“…13 MRI often shows enhancement of the cauda equina, a polymorphonuclear pleocytosis (mean white blood cell count, 651 cells/mm 3 ), and an elevated protein level. 14,15 Positive CMV PCR in the CSF is diagnostic (sensitivity 92%), but evidence of CMV infection elsewhere (eg, retinitis, colitis) is also supportive of the diagnosis. 1 Ganciclovir and foscarnet can be used to treat CMV, but most patients with a CMV-related polyradiculopathy will have residual deficits.…”

Section: Key Pointsmentioning

confidence: 99%

Infections of the Peripheral Nervous System

LoRusso¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWThis article describes infections that affect the peripheral nervous system, including their clinical features, differential diagnoses, and treatments.RECENT FINDINGSRates of pyomyositis have increased recently in the United States, possibly because of an increase in risk factors such as IV drug use, obesity, and diabetes. Other peripheral nervous system infections, such as diphtheria, have become more common in older patients secondary to a lack of revaccination or waning immunity. Although recommended treatment regimens for most infections remain unchanged over recent years, debate over the ideal dosing and route of administration continues for some infections such as tetanus and leprosy (Hansen disease).SUMMARYInfections of the peripheral nervous system are varied in terms of the type of infection, localization, and potential treatment. Nerve conduction studies and EMG can help determine localization, which is key to determining an initial differential diagnosis. It is important to recognize infections quickly to minimize diagnostic delays that could lead to patient morbidity and mortality.

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The utility of clinical and radiographic features in the diagnosis of cytomegalovirus central nervous system disease in AIDS patients

Cited by 12 publications

References 15 publications

Neuroimaging of herpesvirus infections in children

Neuroimaging of herpesvirus infections in children

Successful Treatment of Cytomegalovirus Polyradiculopathy in a 9-year-old Child With Congenital Human Immunodeficiency Virus Infection

Infections of the Peripheral Nervous System

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