ABSTRACT
A cohort of 50 initially asymptomatic seropositive patients have been followed for five years. Various clinical evolution have been observed: 21 remain stable, 29 underwent complications that take then to AIDS, 11 died. In any case, invariability of the MRI anomalies seems had to be imputed to primary infection scars.
Subject(s)
Encephalitis/etiology , HIV Infections/diagnosis , Magnetic Resonance Imaging , Adult , Cohort Studies , Encephalitis/diagnosis , Encephalitis/microbiology , Female , Follow-Up Studies , HIV Infections/complications , Humans , Male , Mass Screening , Middle Aged , Risk FactorsABSTRACT
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease which occurs in immunodepressed subjects and is particularly frequent in AIDS. Some authors having drawn attention to the protean aspect of the disease and claimed that AIDS may lose its basic characteristics and affect the grey matter as well as the white matter, we reviewed a series of 8 patients who had been biopsied and/or autopsied and had been examined at least once by MRI. In this series, contrary to what is regularly observed in toxoplasmic abscesses we did not find any lesion of the grey matter or any mass effect. On the other hand, we confirmed that PLM is not multifocal in all cases and that it course may be interrupted by prolonged remissions. The MRI criteria for PML therefore are reliable, provided multiple T2-weighted slices in coronal plane are performed, clearly showing the anatomy of the white fibres affected. However, it must be borne in mind that HIV-infected patients often have other associated brain pathologies, especially when the immune deficiency increases.
Subject(s)
Acquired Immunodeficiency Syndrome , Leukoencephalopathy, Progressive Multifocal/pathology , Magnetic Resonance Imaging , Acquired Immunodeficiency Syndrome/pathology , Adult , Biopsy , Brain/pathology , Diagnosis, Differential , Encephalitis/pathology , HIV Infections/pathology , Humans , Leukoencephalopathy, Progressive Multifocal/diagnosis , Leukoencephalopathy, Progressive Multifocal/diagnostic imaging , Male , Microscopy, Electron , Middle Aged , Sensitivity and Specificity , Staining and Labeling , Tomography, X-Ray ComputedABSTRACT
In an attempt to determine factors of predictive value in HIV (human immuno-deficiency virus) seropositive patients, particular attention was payed to symptoms indicating early involvement of the central nervous system (CNS). A cohort of healthy carriers was thus constituted. Follow-up will be carried out every six month including clinical, biological as well as CNS imaging by NMR. Among the first 15 of them, abnormalities could be observed in 4 individuals. Lesions consisted in nodules of high signal in T2 which were localized either in the white matter or thalamic nuclei. No relationship could be demonstrated between the existence of these lesions and various criteria such as age, sex, risk factors and T4 cells count. Such lesions appeared similar to the localizations observed in multiple sclerosis or to the scars of limited vascular accidents. The nature of these lesions is not clear. They certainly indicate early involvement of CNS after primary infection by the HIV virus. They may either represent sequellae of this primary infection or early alterations announcing developing encephalopathy.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Brain Diseases/pathology , Magnetic Resonance Imaging , AIDS-Related Complex/complications , Adult , Encephalitis/diagnosis , Female , HIV Seropositivity/complications , Humans , Male , Middle Aged , PrognosisABSTRACT
Central Nervous System (CNS) involvement, whether primary by the Human Immunodeficiency Virus--HIV--itself, or secondary (toxoplasmosis or lymphoma) is remarkably frequent in AIDS, in 40 to 70% of cases, depending upon the author. In order to study the natural history of this illness, a cohort of 25 asymptomatic seropositive patients have been established. Every 6 months these patients undergo biological and clinical examinations, as well as Magnetic Resonance brain scans. After two examinations at a 6 month's interval, the first results are reported. Out of these 25 cases, 9 present anomalies: One patient with diffuse cerebral atrophy and 8 others with high signal intensity areas on T2 weighted sequences, like those of the Multiple Sclerosis. No relationship could be demonstrated between the existence of these lesions and various criteria such as age, sex, risk factors and T4 cells count. The nature of these lesions is not clear. They certainly indicate early involvement of the CNS after primary infection by the HIV virus. They may either represent scars of the primary infection or early alterations announcing developing encephalopathy.
