Choreoathetosis in acquired immune deficiency syndrome patients with cerebral toxoplasmosis
Choreoathetosis in acquired immune deficiency syndrome patients with cerebral toxoplasmosis
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DOI：
10.1002/mds.870110414
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发表时间：
1996-07-01
影响因子：
8.6
通讯作者：
Angarano, G
中科院分区：
文献类型：
--
作者：
Maggi, P;deMari, M;Angarano, G
本研究的目的是评估合并脑弓形虫病的获得性免疫缺陷综合征（AIDS）患者锥体外系疾病的发病率、病理和临床特征。在1985-1994年期间评价的240名艾滋病患者中。其中50人根据以下标准诊断为脑弓形虫病：特异性抗体的出现、计算机断层扫描和/或磁共振成像（MRI）以及特异性治疗后症状的消退。50例患者中有3例（6%）有偏侧手足徐动症。在第一个病例中，这种疾病开始于左手的运动障碍，随后扩散到整个同侧手臂，并呈现舞蹈性手足徐动的特征。另2例表现为左半球躯干远端舞蹈性运动。用乙胺嘧啶和磺胺嘧啶治疗导致两例锥体外系症状完全恢复，第三例症状改善。根据我们的观察，这些运动障碍的发作可能与病变的大小或水肿无关，但与丘脑底核的特定定位有关。苍白球和苍白球/丘脑通路。MRI似乎是一种选择性工具，可以更准确地研究该通路中涉及的解剖区域并验证其完整性。艾滋病合并脑弓形虫病可能是舞蹈徐动症的一个新的病因。
The aim of our study was to evaluate both the incidence and the pathologic and clinical features of extrapyramidal disorders in a population of acquired immune deficiency syndrome (AIDS) patients with cerebral toxoplasmosis. Of 240 AIDS patients evaluated in the 1985-1994 period. 50 of them were diagnosed to have cerebral toxoplasmosis on the basis of the following criteria: occurrence of specific antibodies, computed tomography and/or magnetic resonance imaging (MRI), and regression of the symptoms after specific therapy. Three of 50 (6%) had hemichoreoathetosis. In the first case, the disorder began as a dyskinesia of the left hand that subsequently spread to the whole ipsilateral arm and assumed the features of choreic athetotic movements. The other two cases were characterized by left hemisomatic distal choreic movements. Therapy with pyrimethamine and sulfadiazine led to a complete recovery of the extrapyramidal signs in two cases and to improvement in the third. According to our observations, the onset of these movement disorders could not be related to the dimension of the lesion or to the edema, but to a specific localization in subthalamic nucleus, in subthalamic!pallidal, and pallidal/thalamic pathways. MRI seems the elective tool to perform a more accurate study of the anatomic areas involved in this pathway and to verify their integrity. Cerebral toxoplasmosis in AIDS san be considered as a new etiopathogenic cause of choreoathetosis.