CEREBRAL INFARCTIONS AND TRANSIENT NEUROLOGIC DEFICITS ASSOCIATED WITH ACQUIRED IMMUNODEFICIENCY SYNDROME
CEREBRAL INFARCTIONS AND TRANSIENT NEUROLOGIC DEFICITS ASSOCIATED WITH ACQUIRED IMMUNODEFICIENCY SYNDROME
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DOI：
10.1016/0002-9343(89)90379-3
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发表时间：
1989-05-01
影响因子：
5.9
通讯作者：
BREDESEN, DE
中科院分区：
文献类型：
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作者：
ENGSTROM, JW;LOWENSTEIN, DH;BREDESEN, DE
目得：关于获得性免疫缺陷综合征（AIDS）患者脑梗死的临床重要性，目前尚无相关资料。这项回顾性研究的目的有两个：（1）确定艾滋病患者脑梗死和短暂性神经功能缺损（TND）的频率和临床特征;（2）确定具有此类并发症风险的特定患者亚组以及是否存在需要特定治疗的潜在相关疾病。患者和方法：神经科住院和咨询服务记录，神经病理学报告，和加州大学弗朗西斯科分校艾滋病计算机化登记用于确定研究病例。从每位患者的病历中获得有关人口统计学背景、相关临床诊断、神经系统症状和体征、实验室检查结果、病理学检查结果和临床随访的信息。研究结果：25例艾滋病患者（平均年龄38岁）的临床或病理结果提示局灶性脑缺血或梗死被确定。10例患者有非出血性脑梗死，13例有急性TND，2例两者兼而有之。脑梗死与中枢神经系统（CNS）感染（隐球菌，4例;结核，1例;带状血管炎，1例）和CNS卡波西肉瘤（1例）相关。5例脑梗死和8例TND的假定原因是不存在的。所有5例经病理证实的肉眼可见脑梗死患者均在死亡前被临床诊断。结论：我们得出以下结论：（1）艾滋病患者，特别是年轻人，似乎有更高的脑梗死和TND风险。(2)脑梗死和TND可能是AIDS的首发表现。(3)TND和脑梗死往往意味着可治疗的中枢神经系统感染的艾滋病患者。(4)艾滋病相关性脑梗死和TND的原因在许多情况下是未知的。
PURPOSE: Little formation is available concerning the clinical importance of cerebral infarction in patients with acquired immunodeficiency syndrome (AIDS). The purpose of this retrospective study was two-fold: (1) to determine the frequency and clinical characteristics of cerebral infarction and transient neurologic deficits (TNDs) among patients with AIDS; and (2) to identify specific patient subgroups at risk for such complications and whether there were underlying associated diseases requiring specific therapy. PATIENTS AND METHODS: Neurology inpatient and consult service records, neuropathology reports, and the University of California, San Francisco, AIDS computerized registry were used in identifying study cases. Information on demographic background, associated clinical diagnoses, presenting neurologic symptoms and signs, laboratory results, pathologic findings, and clinical follow-up was obtained from each patient''s medical record. RESULTS: Twenty-five patients with AIDS (mean age, 38) having clinical or pathologic findings suggestive of focal cerebral ischemia or infarction were identified. Ten patients had non-hemorrhagic cerebral infarctions, 13 had acute TNDs, and two had both. Cerebral infarction was associated with central nervous system (CNS) infections (cryptococcus, four; tuberculosis, one; zoster vasculitis, one) and CNS Kaposi''s sarcoma (one). A presumptive cause was absent in five cases of cerebral infarction and eight of TND. All five patients with pathologically proven macroscopic cerebral infarcts were diagnosed clinically before the death. CONCLUSIONS: We conclude the following: (1) AIDS patients, especially given their young age, appear to be at increased risk for cerebral infarction and TND. (2) Cerebral infarction and TND may be the initial presentation of AIDS. (3) TND and cerebral infarction often signify treatable CNS infection among AIDS patients. (4) The causes of AIDS-related cerebral infarction and TND are unknown in many cases.