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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.53 no.1 São Paulo Mar. 1995

http://dx.doi.org/10.1590/S0004-282X1995000100018 

Hemicorea asociada a toxoplasmosis cerebral y SIDA

 

Hemichorea in a patient with toxoplasmosis and AIDS

 

 

N.S. garretto; J.A. Bueri; M. Kremenchutzky; D. Consalvo; M. Segura; O. Genovese

Division y Catedra de Neurologia, Universidad de Buenos Aires: Hospital J. M. Ramos Mejia

 

 


RESUMEN

Se observan complicaciones neurológicas en 40% de enfermos con SIDA. De estos, en 10% puede ser la manifestation inicial de la enfermedad. En otro 11% pueden aparecer trastornos del movimiento. Comunicamos el primer caso de hemicorea asociada a toxoplasmosis cerebral y SIDA en nuestro pais. Hombre de 26 anos, con diagnostico de SIDA y toxoplasmosis cerebral. Habia comenzado con crisis motoras simples de hemicuerpo izquierdo, con generalization secundaria y luego perdida de fuerza progresiva en dicho hemicuerpo. La RMN de cérebro mostro una lesion frontal derecha y otra temporo-occipital izquierda, con gran edema perilesional y efecto de masa. Las serologias para HIV y toxoplasmosis fueron positivas. Comenzo tratamiento con sulfadiazina y pirimetamina. Al duodecimo dia aparecieron movimientos involuntários dei pie izquierdo, coreicos, que se extendieron mas tarde a todo ese miembro inferior y luego al hemicuerpo. Nueva RMN de cérebro mostro disminucion dei edema y efecto de masa de las lesiones. Sin embargo, se observo una nueva lesion a nivel peduncular derecho. Movimientos involuntarios en pacientes con toxoplasmosis cerebral comenzaron a describirse recientemente solo en pacientes con SIDA. El presente seria el decimotercer caso de la literatura mundial y el primero en nuestro pais de hemicorea asociada a toxoplasmosis y SIDA.

Palabras llave: SIDA (AIDS), toxoplasmosis cerebral, hemicorea.


SUMMARY

Only 12 AIDS cases with hemichorea were reported in the literature. We report the first case of hemichorea associated with AIDS and cerebral toxoplasmosis in our country. A 26-year-old man had 3 episodes of focal seizures on the left side with subsequent loss of consciousness. A few weeks later, he noticed progressive left-sided weakness. Examination revealed a left hemiparesis. MRI of the head showed a round mass in the right frontal lobe and a smaller lesion in the left temporo-occipital area. Laboratory showed positive serum ELISA and Western Blot analysis for HIV antibodies. Serum tests for Toxoplasma showed elevated titers. He was treated with pyrimethamine and sulfadiazine. His weakness improved and he had no further seizures. Two weeks later, choreic movements appeared in the left foot, finally involving the entire left hemibody. A second MRI showed a new small lesion in the right cerebral peduncle. The patient completed 6 weeks of treatment, with further reduction in the size of the lesions. Nevertheless, the left hemichorea persisted. We believe that the hemichorea our patient had was caused by the contralateral peduncular lesion. Lesions involving the subthalamic nucleus or its connections may cause contralateral hemiballismus or hemichorea. In spite of the favorable response to antitoxoplasmic therapy, the hemichorea persisted. The present report illustrates an uncommon neurological complication in AIDS. We believe that a combination of a focal cerebral lesion and the HIV infection caused the movement disorder presented by the patient.

Key words:AIDS, cerebral toxoplasmosis, hemichorea.


 

 

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Aceite: 15-setembro-1994.

 

 

Dra. Nelida Susana Garretto - Division Neurologia, Hospital J. M. Ramos Mejia - Urquiza 609 - 1221 Buenos Aires - Argentina.