Involuntary movements and AIDS: report op seven cases and review of the literature

Mattos, James Pitágoras de; Rosso, Ana Lúcia Z.; Corrêa, Rosalie Branco; Novis, Sérgio

doi:10.1590/S0004-282X1993000400011

Abstracts

We studied 1086 AIDS patients in the last six years. Of these 389 (35.82%) had neurological manifestation and 7 (1.8%) male patients had abnormal involuntary movements (parkinsonism in 3, hemichorea-hemiballism in 2, spinal myoclonus in 1 and rubral tremor in another). All patients were men, 5 white and 2 black. Four were homosexual, 2 drug-users and 1 bisexual. The mean age was 33.14 years. The time between AIDS diagnosis and the onset of movement disorders was 23.8 months in 5 patients and in 2 it was the first symptom. The parkinsonian patients did not show any opportunistic infection in conection with the neurological symptoms but in the remaining four cases this relationship was suggested. The data showed that not only the opportunistic infection but also the AIDS virus may play an important role on the development of involuntary movements.

movement disorders; AIDS; toxoplasmosis; parkinsonism

Nos últimos 7 anos, estudamos a incidência de movimentos) involuntários anormais em 1086 pacientes com AIDS. Destes, 389 (35,82%) tinham manifestações neurológicas e 7 (1,8%) apresentaram movimentos involuntários anormais. Todos eram homens, com média de idade de 33,14 anos. O tempo médio entre o diagnóstico de AIDS e o início dos movimentos involuntários foi 23,8 meses em 5 pacientes. Nos 2 casos restantes, os movimentos anormais inauguraram o quadro de AIDS. Três pacientes apresentaram parkinsonismo, 2 hemicoréia-hemi-balismo, 1 mioclonia medular e 1 tremor rubral. Quatro eram homossexuais, 2 usuários de drogas endovenosas e 1 bissexual. Infecção oportunista em atividade não foi evidenciada na época do aparecimento dos sintomas parkinsonianos em 3 pacientes, porém, no restante, sua presença foi confirmada (toxoplasmose cerebral em 2, tuberculose em 1 e co-infecção por toxoplasmose e tuberculose em outro). Os dados mostram que, não só as infecções oportunistas, mas também o vírus HIV pode desempenhar importante papel na gênese dos movimentos involuntários.

desordens do movimento; AIDS; toxoplasmose; parkinsonismo

Involuntary movements and AIDS: report op seven cases and review of the literature

Movimentos involuntários e AIDS: relato de sete casos e revisão da literatura

James Pitágoras de Mattos^I; Ana Lúcia Z. Rosso^II; Rosalie Branco Corrêa^II; Sérgio Novis^III

^IProfessor Adjunto, Chefe de Setor; Serviço de Neurologia, Setor de Doenças Extrapiramidais, Hospital Universitário Clementino Fraga Filho, (HUCFF). Universidade Federal do Rio de Janeiro (UFRJ)

^IIMédica; Serviço de Neurologia, Setor de Doenças Extrapiramidais, Hospital Universitário Clementino Fraga Filho, (HUCFF). Universidade Federal do Rio de Janeiro (UFRJ)

^IIIProfessor Titular, Chefe de Serviço. Serviço de Neurologia, Setor de Doenças Extrapiramidais, Hospital Universitário Clementino Fraga Filho, (HUCFF). Universidade Federal do Rio de Janeiro (UFRJ)

SUMMARY

We studied 1086 AIDS patients in the last six years. Of these 389 (35.82%) had neurological manifestation and 7 (1.8%) male patients had abnormal involuntary movements (parkinsonism in 3, hemichorea-hemiballism in 2, spinal myoclonus in 1 and rubral tremor in another). All patients were men, 5 white and 2 black. Four were homosexual, 2 drug-users and 1 bisexual. The mean age was 33.14 years. The time between AIDS diagnosis and the onset of movement disorders was 23.8 months in 5 patients and in 2 it was the first symptom. The parkinsonian patients did not show any opportunistic infection in conection with the neurological symptoms but in the remaining four cases this relationship was suggested. The data showed that not only the opportunistic infection but also the AIDS virus may play an important role on the development of involuntary movements.

Key words: movement disorders, AIDS, toxoplasmosis, parkinsonism.

RESUMO

Nos últimos 7 anos, estudamos a incidência de movimentos) involuntários anormais em 1086 pacientes com AIDS. Destes, 389 (35,82%) tinham manifestações neurológicas e 7 (1,8%) apresentaram movimentos involuntários anormais. Todos eram homens, com média de idade de 33,14 anos. O tempo médio entre o diagnóstico de AIDS e o início dos movimentos involuntários foi 23,8 meses em 5 pacientes. Nos 2 casos restantes, os movimentos anormais inauguraram o quadro de AIDS. Três pacientes apresentaram parkinsonismo, 2 hemicoréia-hemi-balismo, 1 mioclonia medular e 1 tremor rubral. Quatro eram homossexuais, 2 usuários de drogas endovenosas e 1 bissexual. Infecção oportunista em atividade não foi evidenciada na época do aparecimento dos sintomas parkinsonianos em 3 pacientes, porém, no restante, sua presença foi confirmada (toxoplasmose cerebral em 2, tuberculose em 1 e co-infecção por toxoplasmose e tuberculose em outro). Os dados mostram que, não só as infecções oportunistas, mas também o vírus HIV pode desempenhar importante papel na gênese dos movimentos involuntários.

Palavras-chave: desordens do movimento, AIDS, toxoplasmose, parkinsonismo.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 18-março-1993.

Dr. James Pitágoras de Mattos Av. São Sebastião 165/101 - 22291-070 Rio de Janeiro RJ -Brasil.

1. Cabral NL, Becker N, Teive HAG, Werneck LC. Hemi-coréia por granuloma fúngico em paciente aidético: relato de caso. Arq Neuropsiquiatr 1992, 50(Supl) :171.
2. Carrazanna E, Rossitch B, Samuels MA. Parkinsonian symptoms in a patient with AIDS and cerebral toxoplasmosis. J Neurol Neurosurg Psychiatry 1989, 52:1445-1446.
3. Fonseca LC, Tedrus GMA, Albertin MC. Balismo como manifestação inicial de snídrome de imunodeficiência adquirida: relato de caso. Arq Neuropsiquiatr 1992, 50(Supl) :145.
4. Hriso E, Kuhn T, Masdeu JC, Grundman M. Extrapyramidal symptoms due to dopa-mine-bloking agents in patients with AIDS encephalopathy. Am J Psychiatry 1991, 148: 1558-1561.
5. Koppel BS, Daras M. Rubral tremor due to midbrain toxoplasmosis abscess. Movement Disord 1990, 5:254-256.
6. Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of the acquired immunodeficiency syndrome (AIDS) : experience at UCSF and review of the literature. J Neurosurg 1985, 62:475-495.
7. Martínez-Martín P. Hemichorea-hemiballism in AIDS. Movement Disord 1990, 5:180.
8. Metzer WS. Movement disorders with AIDS encephalopathy: case report. Neurology 1987, 37:1438.
9. Nath A, Hobson DE, Russell A. Movement disorders with cerebral toxoplasmosis and AIDS. Movement Disord 1993, 8:107-112.
10. Nath A, Jankovic J, Pettigrew C. Movement disorders and AIDS. Neurology 1987, 37: 37-41.
11. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann Neurol 1986, 19:517-524.
12. Navia BA, Petito CK, Gold JWM, Cho E, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19:224-238.
13. Pestre P, Milandre L, Farnarier P, Gallais H. Hémichorée au cours du syndrome d'immu-nedéficience acquise: abcès toxoplasmiques dans le striatum. Rev Neurol (Paris) 1991, 147:833-837.
14. Sanchez-Ramos JR, Factor SA, Weiner WJ, Marquez J. Hemichorea-hemiballism associated with acquired immune deficiency syndrome and cerebral toxoplasmosis. Movement Disord 1989, 4:266-273.
15. Singer C, Berger J, Weiner W, Sanchez-Ramos J. Movement Disorder in acquired immunedeficiency syndrome. Movement Disord 1991, 6:275.
16. Singer C, Berger JR, Bowen BC, Bruce JH, Weiner WJ. Akinetic-rigid syndrome in a 13-year-old girl with HIV-related progressive multifocal leukoencephalopathy. Movement Disord 1989, 4:266-273.
17. Sohler MP. Manifestações neurológicas da síndrome de imunodeficiência adquirida. Tese de Mestrado (UFF), 1991.
18. Tolge CF, Factor SA. Focal dystonia secondary to cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome. Movement Disord 1991, 6:69-72.
19. Vergara TRC, Carvalho JJF, Oliveira CAB, Gonçalves AJR. Manifestações neurológicas da síndrome de imunodeficiência adquirida. Arq Bras Med 1986, 60:173-190.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Nov 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Cabral NL, Becker N, Teive HAG, Werneck LC. Hemi-coréia por granuloma fúngico em paciente aidético: relato de caso. Arq Neuropsiquiatr 1992, 50(Supl) :171.

[2] 2. Carrazanna E, Rossitch B, Samuels MA. Parkinsonian symptoms in a patient with AIDS and cerebral toxoplasmosis. J Neurol Neurosurg Psychiatry 1989, 52:1445-1446.

[3] 3. Fonseca LC, Tedrus GMA, Albertin MC. Balismo como manifestação inicial de snídrome de imunodeficiência adquirida: relato de caso. Arq Neuropsiquiatr 1992, 50(Supl) :145.

[4] 4. Hriso E, Kuhn T, Masdeu JC, Grundman M. Extrapyramidal symptoms due to dopa-mine-bloking agents in patients with AIDS encephalopathy. Am J Psychiatry 1991, 148: 1558-1561.

[5] 5. Koppel BS, Daras M. Rubral tremor due to midbrain toxoplasmosis abscess. Movement Disord 1990, 5:254-256.

[6] 6. Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of the acquired immunodeficiency syndrome (AIDS) : experience at UCSF and review of the literature. J Neurosurg 1985, 62:475-495.

[7] 7. Martínez-Martín P. Hemichorea-hemiballism in AIDS. Movement Disord 1990, 5:180.

[8] 8. Metzer WS. Movement disorders with AIDS encephalopathy: case report. Neurology 1987, 37:1438.

[9] 9. Nath A, Hobson DE, Russell A. Movement disorders with cerebral toxoplasmosis and AIDS. Movement Disord 1993, 8:107-112.

[10] 10. Nath A, Jankovic J, Pettigrew C. Movement disorders and AIDS. Neurology 1987, 37: 37-41.

[11] 11. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann Neurol 1986, 19:517-524.

[12] 12. Navia BA, Petito CK, Gold JWM, Cho E, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19:224-238.

[13] 13. Pestre P, Milandre L, Farnarier P, Gallais H. Hémichorée au cours du syndrome d'immu-nedéficience acquise: abcès toxoplasmiques dans le striatum. Rev Neurol (Paris) 1991, 147:833-837.

[14] 14. Sanchez-Ramos JR, Factor SA, Weiner WJ, Marquez J. Hemichorea-hemiballism associated with acquired immune deficiency syndrome and cerebral toxoplasmosis. Movement Disord 1989, 4:266-273.

[15] 15. Singer C, Berger J, Weiner W, Sanchez-Ramos J. Movement Disorder in acquired immunedeficiency syndrome. Movement Disord 1991, 6:275.

[16] 16. Singer C, Berger JR, Bowen BC, Bruce JH, Weiner WJ. Akinetic-rigid syndrome in a 13-year-old girl with HIV-related progressive multifocal leukoencephalopathy. Movement Disord 1989, 4:266-273.

[17] 17. Sohler MP. Manifestações neurológicas da síndrome de imunodeficiência adquirida. Tese de Mestrado (UFF), 1991.

[18] 18. Tolge CF, Factor SA. Focal dystonia secondary to cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome. Movement Disord 1991, 6:69-72.

[19] 19. Vergara TRC, Carvalho JJF, Oliveira CAB, Gonçalves AJR. Manifestações neurológicas da síndrome de imunodeficiência adquirida. Arq Bras Med 1986, 60:173-190.