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

Acquired immunodeficiency syndrome: neurologic complications in 44 cases

Resumos

De 280 pacientes com anticorpos anti-HIV, 44 apresentaram manifestações neurológicas centrais. O quadro neurológico foi a manifestação inicial da AIDS em 13,5% dos casos. Déficit motor, cefaléia, sinais meníngeos e alterações do comportamento foram as manifestações mais freqüentes. A toxoplasmose cerebral, as meningites criptocócica e tuberculosa representaram 79,4% das complicações observadas. Os achados do liqüido cefalorraquidiano nos pacientes com meningite eram em geral inespecíficos, exceto pelo isolamento do Cryptococcus neoformans no exame direto e/ou cultura. A tomografia computadorizada de crânio comu-mente revelou lesões hipodensas, geralmente múltiplas, sem captação ou com captação anelar de contraste, predominando em regiões hemisféricas profundas. O tempo de doença do SNC foi inferior a 6 meses em 29 casos. Observou-se que 90,4% dos pacientes evoluíram para o óbito e nenhum destes sobreviveu por mais de 12 meses.


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 neofarms 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 occasionaly 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.


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

Acquired immunodeficiency syndrome: neurologic complications in 44 cases

Marzia PuccioniI; Ana Cristina FavoretoII; Charles AndréI; Carlos A. PeixotoIII; Sergio A. P. NovisIV

IHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Serviço de Neurologia e Serviço de Doenças Infecciosas e Parasitárias: Neurologista do HUCFF-UFRJ

IIHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Serviço de Neurologia e Serviço de Doenças Infecciosas e Parasitárias: Ex-Residente do INDC-UFRJ

IIIHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Serviço de Neurologia e Serviço de Doenças Infecciosas e Parasitárias: Infectologista do HUCFF-UFRJ

IVHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Serviço de Neurologia e Serviço de Doenças Infecciosas e Parasitárias: Professor Titular e Chefe do Serviço de Neurologia do HUCFF-UFRJ

RESUMO

De 280 pacientes com anticorpos anti-HIV, 44 apresentaram manifestações neurológicas centrais. O quadro neurológico foi a manifestação inicial da AIDS em 13,5% dos casos. Déficit motor, cefaléia, sinais meníngeos e alterações do comportamento foram as manifestações mais freqüentes. A toxoplasmose cerebral, as meningites criptocócica e tuberculosa representaram 79,4% das complicações observadas. Os achados do liqüido cefalorraquidiano nos pacientes com meningite eram em geral inespecíficos, exceto pelo isolamento do Cryptococcus neoformans no exame direto e/ou cultura. A tomografia computadorizada de crânio comu-mente revelou lesões hipodensas, geralmente múltiplas, sem captação ou com captação anelar de contraste, predominando em regiões hemisféricas profundas. O tempo de doença do SNC foi inferior a 6 meses em 29 casos. Observou-se que 90,4% dos pacientes evoluíram para o óbito e nenhum destes sobreviveu por mais de 12 meses.

SUMMARY

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 neofarms 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 occasionaly 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.

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Este artigo constitui parte do trabalho laureado pela Academia Nacional de Medicina: Prêmio Antonio Austregésilo-1988.

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Datas de Publicação

  • Publicação nesta coleção
    01 Jun 2011
  • Data do Fascículo
    Dez 1989
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