CEREBRAL TOXOPLASMOSIS COMPLICATING THE ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME - CLINICAL AND NEUROPATHOLOGICAL FINDINGS IN 27 PATIENTS
CEREBRAL TOXOPLASMOSIS COMPLICATING THE ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME - CLINICAL AND NEUROPATHOLOGICAL FINDINGS IN 27 PATIENTS
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DOI：
10.1002/ana.410190303
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发表时间：
1986-03-01
影响因子：
11.2
通讯作者：
PRICE, RW
中科院分区：
文献类型：
--
作者：
NAVIA, BA;PETITO, CK;PRICE, RW
我们回顾了27例脑弓形虫病合并获得性免疫缺陷综合征患者的临床、神经放射学和血清学表现，其中19例还进行了神经病理学分析。这种疾病的临床表现多种多样，从头痛、发烧到昏迷。然而，特征性表现包括局灶性神经系统症状和体征，通常为亚急性发作。此外，三分之二的患者表现出更广泛的脑功能障碍，伴有意识模糊和嗜睡。计算机断层扫描（CT）最常显示环形对比增强，这似乎与肿瘤周围血管增生和炎症的组织学存在最相关。5例增强扫描呈均匀强化或无强化，3例阴性。一般来说，CT扫描不能充分代表最终病理记录的病变数量。双剂量对比剂管理和磁共振成像的初步经验表明，这些技术是优于标准CT扫描检测弓形虫病变上级。所有患者的血清中弓形虫IgG抗体阳性的血液中，无论是在发病前，并在介绍时，虽然在一些患者的滴度低至1：8，大多数患者并没有表现出上升的滴度。及时治疗导致快速临床改善，通过CT扫描记录，与宿主中组织化组织反应的发展和游离微生物的消除相关。在大多数患者中，对治疗的反应足够迅速，允许将治疗试验作为首选的诊断方法。
We reviewed the clinical, neuroradiological, and serological findings in 27 patients with cerebral toxoplasmosis complicating the acquired immune deficiency syndrome, 19 of whom were also analyzed neuropathologically. The clinical manifestations of this disorder varied, ranging from headache and fever to coma. However, the characteristic presentation included focal neurological symptoms and signs, usually of subacute onset. In addition, two-thirds of the patients exhibited more generalized cerebral dysfunction with confusion and lethargy. The computed tomographic (CT) scan most commonly revealed ring contrast enhancement, which appeared to correlate best with the histological presence of vascular proliferation and inflammation surrounding the abscesses. However, in 5 patients the CT scan revealed either homogeneous enhancement or no enhancement, and in 3 patients the scans were negative. In general, CT scans underrepresented the number of lesions eventually documented pathologically. Double-dose contrast administration and preliminary experience with magnetic resonance imaging suggested that these techniques were superior to standard CT scanning in detecting Toxoplasma lesions. All patients were seropositive for IgG antibody against Toxoplasma gondii in blood, both before the onset of illness and at the time of presentation, although titers in some patients were as low as 1:8 and most patients did not exhibit rising titers. Prompt therapy resulted in rapid clinical improvement, documented by CT scan, associated with the development of an organizing tissue response in the host and elimination of free organisms. Response to treatment was sufficiently rapid in most patients to allow a trial of therapy as the favored approach to diagnosis.