Brainstem CMV encephalitis in AIDS: clinical case and MRI features.

We describe the clinical case and MRI findings of a patient with acquired immune deficiency syndrome and pathologically confirmed cytomegalovirus encephalitis. Prevalent brainstem and cerebellar signs together with almost exclusive involvement as seen on MRI of posterior fossa structures at the onset of the symptoms were the main features of our case.

Multimodal evoked potentials in HIV-1-seropositive patients: relationship between the immune impairment and the neurophysiological function.

Multimodal evoked potentials (PRVEP, BAEP, mSEP) were recorded in 56 HIV-1 seropositive outpatients free from opportunistic CNS pathologies and/or overt HIV-1 encephalopathy. EPs were altered in 17 of 39 (43.6%) seropositive subjects without AIDS (group A) and in 13 of 17 (76.5%) patients with AIDS (group B). A high incidence of subclinical alterations (30.8%) were found in group A patients. Significant BAEP (I-III, III-V, I-V) interpeak latency and mSEP (N9-N13, N9-N20) conduction time prolongations were found in group A and B patients. PRVEP P100 was significantly prolonged only in group B. An inverse relationship between BAEP interpeak latencies and CD4 count was found. Our findings support the hypothesis of an important role of immunodepression in the development of neurophysiologic abnormalities, together with a preferential involvement of acoustic pathways, in the course of HIV-1 infection.

Myopathy in long-term AZT therapy: clinical, electrophysiological and biopsy study in 67 HIV+ subjects.

The occurrence of muscular pathologies in AZT treated subjects has been evaluated in 67 HIV seropositive outpatients (56 AZT-treated and 11 untreated controls) in a neurological clinical and paraclinical follow-up study. Standard electromyographic and electrodiagnostic examinations, together with muscle enzyme determination, were performed in every subject, and periodically repeated at fixed intervals; in 11 patients a muscle biopsy sample was also obtained. An AZT-related myopathy was diagnosed in 8 biopsied cases; 9 more patients were considered to have AZT myopathy on clinical, EMG and ex juvantibus criteria. Statistical analysis showed that treatment duration was more relevant to the development of the myopathy than AZT dosage, though an individual predisposition could not be excluded, at least in a small number of cases. The risk of developing a toxic myopathy will therefore have to be considered when evaluating long-term effects of AZT therapy.

Predictive value of neurological abnormalities in HIV 1 patients in the early stages of the infection.

A longitudinal clinical neurological and electrophysiological follow-up study was carried out on 31 HIV1 seropositive outpatients in the asymptomatic or LAS stages of the infection (CDC II-III). The results of clinical examination and multimodal evoked potentials (EP) recording showed a high percentage of abnormalities (42% and 39% of cases respectively); in a statistically significant number of subjects these abnormalities were predictive of subsequent immunological deterioration, thus demonstrating the close relationship between neurological and immunological functions in HIV1 infection.

Electrophysiological study (VEP, BAEP) in HIV-1 seropositive patients with and without AIDS.

One hundred-twenty nine HIV-1 seropositive patients (39 females, 90 males) were studied by means of pattern visual evoked potential (VEP) and brainstem auditory evoked potential (BAEP) recording. Utilizing the criteria of the Centers for Disease Control the patients were clinically defined and then subdivided into four groups: group A included patients of category II (n:11); group B patients of category III (n:29); group C patients of category IVa and IVc2 (n:55) and group D patients belonging to the other subgroups of category IV (n:34). EP were altered in 26.35% of the entire group with a marked prevalence of BAEP alterations (21.7%) rather than of VEP (4.65%). A considerable amount of BAEP abnormalities (24.13%) were found in patients with persistent generalized lymphadenopathy (group B). A significant increase of BAEP mean interpeak latencies were observed in group B, C, D patients when compared with those of the control group. On the whole, EP were altered in 20.65% of the neurologically asymptomatic patients. EP alterations may precede any clinical manifestation and can be found during the earlier phases of HIV-1 infection.

AZT-induced mitochondrial myopathy.

Histochemical, electron microscopy and biochemical studies were performed on muscle biopsy specimens from 11 AIDS patients treated with zidovudine. A peculiar association of structural abnormalities and mitochondrial dysfunction was found. Focal cytochrome c oxidase (COX) deficiency was evident in muscle sections from 9 patients, 8 of whom had received long-term treatment while one had been treated for 1 month only. Electron microscopy showed changes in number, size and structure of mitochondria. Biochemical studies proved partial COX and succinate cytochrome c reductase (SCR) deficiency in 4 patients; one patient had only reduced SCR activity. Our data confirm that AZT therapy can cause toxic myopathy with mitochondrial dysfunction.

[Hemicrania-epilepsy syndrome: clinical contribution and pathogenetic interpretation]. / La sindrome di emicrania-epilessia: contributo clinico ed interpretazione patogenetica.

6 patients suffering from migraine and consciousness disturbances occurring together in a significant chronologic association were selected retrospectively. Clinical, radiologic and electroencephalographic data are reported; the hypothesis of a common pathogenesis of the two syndromes is discussed by means of the "neural" theory of migraine and the results of cerebral blood flow studies in migrainous subjects. In addition, the therapeutic effectiveness of the pharmacologic association between calcium-antagonists and antiepileptic drugs in some patients is remarked.

[2 cases of Binswanger's disease not associated with arterial hypertension: clinical-instrumental and neuropsychological evaluation]. / Su due casi di malattia di Binswanger non associata ad ipertensione arteriosa: valutazione clinico-strumentale e neuropsicologica.

Two cases of subcortical arteriosclerotic encephalopathy (Binswanger's disease) are reported. The two patients lacked a clinical history of hypertension, relevant pathogenetic factor in the development of the small and medium size cerebral arteries atherosclerosis, which is the main pathologic finding of the disease. The two subjects clinically showed a marked intellectual deterioration, together with mood depression and focal neurological signs, that were an expression of the multifocal neurologic involvement. In both cases CT scans evidentiated a mainly periventricular leucoencephalopathy associated, in the first patient, with small multiple ischemic lesions and, in the second, with a unique hypodense area in the centrum semiovale. A review of the literature on the subjects is proposed, together with an attempt of pathogenetic interpretation of our two cases.

Preliminary reports on a therapeutical trial in multiple sclerosis.

A therapeutic trial with azathioprine and steroids has been carried out on a group of definite MS subjects. Such pharmacologic association was suggested by many observations pointing out the possibility of balancing the adverse effects of azathioprine by steroid administration. The therapeutic protocol included an alternate administration of azathioprine 2 mg/Kg/die for 15 consecutive days, followed by triamcinolone 40 mg IM in a single dose during the following 15 days. The patient population was composed of 34 subjects, 7 of which showed a RR course, 15 a RP form and 12 a CP course. Our results showed that this treatment appeared particularly useful in RP forms; it could also be indicated in CP forms, at the beginning of chronic progression.

Reduction of circulating suppressor inducer T lymphocytes in the exacerbation phase of remitting-relapse multiple sclerosis.

We studied peripheral blood mononuclear cells (PBMC) from 34 multiple sclerosis (MS) patients: 8 had chronic progressive (CP) and 26 with a relapsing-remitting (RR) course. PBMC were tested with a panel of monoclonal antibodies (MoAbs) including anti-CD3, CD4, CD8, CD25 reagents. In addition, the suppressor inducer lymphocyte subset was investigated by using two color staining with anti-CD4 and G1-15 and/or anti-CD4 and anti-Leu-8 MoaAbs. A significant decrease of the suppressor inducer subset was found in the exacerbation phase of the RR form. Furthermore, a significant decrease of CD8+ (suppressor/cytotoxic) cells was shown in the remission phase of the RR group. Finally, CD25+ lymphocytes were significantly increased in both phases of RR form.

[Changes in slow cerebral potentials (CNV) subsequent to midazolam administration. Double-blind study]. / Modificazioni dei potenziali lenti cerebrali (CNV) in seguito alla somministrazione di midazolam. Studio in doppio cieco.

The result of a study on the modifications of the Expectancy Wave (or Contingent Negative Variation) induced in 10 cases by a new benzodiazepine, midazolam, is reported. A double blind cross-over comparison with placebo has been carried out. The administration of placebo did not give rise to significative variations of the Expectancy Wave after 10, 30 and 240 minutes. The administration of midazolam was followed by a statistically significative reduction of the amplitude of the area and of the maximum peak of the Expectancy Wave. This effect was manifest after 30 minutes from the ingestion of a 15 mg tablet of the drug. After 4 hours both parameters showed again values similar to those observed in basal conditions. Midazolam thus appears to possess a central activity typical of the benzodiazepines group, which is of an early onset and short duration and could be properly utilized on a clinical ground.

[Transitory protracted blindness in hemicrania as a result of vasospasm caused by vertebral angiography]. / Cecità di lunga durata transitoria in emicrania da vasospasmo scatenato dall'angiografia vertebrale.

The arteriographic findings are described in a patient with classic migraine, who developed transitory neurologic complications, during vertebral arteriography by femoral cateterism. Serial films were taken during "comitata" migraine attack and show a progressive decrease in filling of the vertebral-basilar system and partial stenosis of vertebral artery.

[Hemicrania comitata. Critical review and clinical case reports]. / Emicrania comitata. Revisione critica e contributo clinico.

The AA. examined 24 subjects suffering from classic or common migraine and 42 subjects with complicated migraine. In 6 cases of complicated migraine, radiologic investigations (cerebral CT scan or scintigraphy) showed ischemic lesions. The AA. discuss their results, on the basis of the most recent acquisitions concerning the pathogenetic mechanisms involved in the complicated migraine; particularly, they dwell upon "the platelet hypothesis".