1/41. Progressive multifocal leukoencephalopathy (PML) and cerebral toxoplasmosis in an adult patient, with no symptoms of underlying immunosuppressing illness.We present a case of the coincidence of progressive multifocal leukoencephalopathy (PML) and central nervous system (CNS) toxoplasmosis in an adult patient, without a detectable cause of cell-mediated immunity impairment. The proper diagnosis was made postmortem on the basis of histological changes typical of both pathological processes. PML was characterized by the presence of subcortical focal demyelination, containing enlarged, densely basophilic oligodendrocyte nuclei, often with intranuclear inclusion, and bizarre astrocytes, mimicking neoplastic cells. PML was confirmed by detecting numerous papova virus particles in oligo- and astroglial nuclei by thin-section electron microscopy. Cerebral toxoplasmosis was characterized by the presence of multiple well-circumscribed necrotizing abscesses. Numerous toxoplasma gondii (T. gondii) cysts and free, non-encysted protozoan parasites were found among the inflammatory infiltrates. The diagnosis of cerebral toxoplasmosis was further confirmed by immunocytochemistry. In order to detect putative immunosuppressive background underlying both pathological processes, HIV infection was taken into consideration, however, no histopathological changes indicative of AIDS either in the CNS or in the peripheral organs were eventually found. Moreover no HIV provirus genome was identified in the formalin-fixed, paraffin embedded brain tissue by the polymerase chain reaction (PCR). Current view on the selected aspects of the pathogenesis of both disorders were discussed.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
2/41. Non-Hodgkin's lymphoma of the maxillary sinus in a patient with acquired immunodeficiency syndrome.Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies in patients infected with human immunodeficiency virus (HIV): it occurs 25-60 times more frequently in HIV-infected patients than in the general population. This neoplasm in acquired immunodeficiency syndrome (AIDS) patients is a highly aggressive tumour with a poor prognosis and tends to develop in extranodal sites, such as the central nervous system, digestive tract and bone marrow. NHL involving the paranasal sinuses is rare in HIV-infected patients, and is likely to be confused clinically and radiographically with sinusitis; moreover, its optimal treatment is currently uncertain. We present a case of NHL involving the left maxillary sinus in a patient with AIDS. The patient was treated with systemic chemotherapy (low dose-CHOP), but the malignancy did not respond. Subsequently, he was treated with local maxillary sinus irradiation which resulted in partial regression of the neoplasm and in decrease of local symptoms.- - - - - - - - - - ranking = 0.87425506512331keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/41. central nervous system toxoplasmosis in acquired immunodeficiency syndrome: An emerging disease in india.With the incidence of patients infected with human immuno-deficiency virus (HIV) increasing in india, the central nervous system (CNS) manifestations of the disease will be seen more frequently. The CNS may be primarily afflicted by the virus or by opportunistic infections and neoplasms secondary to the immune suppression caused by the virus. In india, although mycobacterium tuberculosis has been reported to be the most common opportunistic infection, toxoplasmosis may become as common owing to the ubiquitous nature of the protozoan. Since an empirical trial of medical therapy without histopathological diagnosis is recommended, the true incidence of this condition may remain under estimated. The role of ancillary tests such as radiology and serology in the initial diagnosis of this condition remain crucial. This report highlights two patients who were diagnosed to have acquired immuno-deficiency syndrome (AIDS) only after the biopsy of the intracranial lesion was reported as toxoplasmosis. Presently all patients for elective neurosurgery are tested for HIV antigen. The management protocol to be followed in a known patient with AIDS presenting with CNS symptoms is discussed in detail. The value of ancillary tests is also reviewed.- - - - - - - - - - ranking = 1.6395040627356keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/41. Failure of screening to detect HIV in a foreign laborer who died of toxoplasmosis of the central nervous system.The most common neurologic complication in patients with acquired immunodeficiency syndrome (AIDS) is cerebral toxoplasmosis. patients with cerebral toxoplasmosis have characteristic findings on clinical examination and neuroimaging. They require prolonged treatment and have a considerable mortality rate. We report a case of cerebral toxoplasmosis in a foreign laborer with AIDS, in whom a human immunodeficiency virus (HIV) screening test failed to detect-HIV infection. The patient, a 23-year-old man from thailand, presented in a confused state 2 weeks after his arrival in taiwan. Computed tomography showed a mass effect, and magnetic resonance imaging showed multiple ring-enhanced lesions in the cerebrum. serologic tests were positive for anti-HIV antibody and also showed high anti-toxoplasma immunoglobulin g titers. Although symptomatic treatment was initiated, the patient's condition deteriorated rapidly and he died of multiple organ failure due to brain stem herniation a few days after admission. As the number of foreign laborers working in taiwan has increased dramatically in recent years, the issues raised by this case are the efficacy of our screening protocols for foreign laborers and the increased occupational hazards encountered by medical personnel in taiwan.- - - - - - - - - - ranking = 3.6227651953699keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
5/41. Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome--four case reports.Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.- - - - - - - - - - ranking = 1.2514898697534keywords = central nervous system, nervous system, brain (Clic here for more details about this article) |
6/41. Parkinsonian symptoms as an initial manifestation in a Japanese patient with acquired immunodeficiency syndrome and toxoplasma infection.We studied a Japanese patient who developed parkinsonian symptoms over 3 months before the diagnosis of acquired immunodeficiency syndrome. Brain MRI showed multiple lesions with mass effect and ring enhancement in the basal ganglia and subcortical white matter suggesting toxoplasma infection. Anti-toxoplasma therapy and highly active antiretroviral therapy for 6 months allowed improvement of parkinsonism, brain MRI findings, and immune system.- - - - - - - - - - ranking = 0.12574493487669keywords = brain (Clic here for more details about this article) |
7/41. hiv-2 infection with cerebral toxoplasmosis and lymphomatoid granulomatosis.A Nigerian man had acute onset of headache and vertigo due to a cerebellar mass. A brain biopsy of the mass revealed toxoplasmosis despite repeated negative hiv-1 serology. The presence of an opportunistic infection and his country of origin raised the suspicion for hiv-2; this was confirmed by positive hiv-2 serology. Despite his preliminary pathological diagnosis, results of physiological magnetic resonance imaging (MRI) (perfusion MRI and proton magnetic resonance spectroscopy) were not typical for toxoplasmosis. The lesion showed a biochemical and perfusion pattern that was intermediate for infectious and neoplastic processes. Further neuropathology confirmed a secondary diagnosis of lymphomatoid granulomatosis.- - - - - - - - - - ranking = 0.12574493487669keywords = brain (Clic here for more details about this article) |
8/41. Holmes' tremor following midbrain toxoplasma abscess: clinical features and treatment of a case.The label Holmes' tremor defines a rare symptomatic movement disorder frequently occurring with midbrain damage. It appears at rest and worsens adopting a posture and on attempting movements. We describe the case of a patient with Holmes' tremor due to a presumed toxoplasma abscess of the midbrain. The positive response to a combined therapy with levodopa and isoniazid is also reported.- - - - - - - - - - ranking = 0.75446960926016keywords = brain (Clic here for more details about this article) |
9/41. Upward gaze paralysis as the initial manifestation of HIV-infected patient: a case report.Upward gaze palsy developed in a 23-year-old man without any other abnormal findings except pupillary light-near dissociation in ocular examination. The neuroradiologic examination was consistent with cerebral toxoplasmosis--the most frequent opportunistic infection of the brain in AIDS patients. The serologic work-up revealed a positive HIV test. Symptoms and neuroradiologic abnormality improved after treatment for cerebral toxoplasmosis. HIV infection should be considered in patients who have upward gaze paralysis and neuroimaging compatible with cerebral toxoplasmosis. Empirical treatment may alleviate the upward gaze palsy.- - - - - - - - - - ranking = 0.12574493487669keywords = brain (Clic here for more details about this article) |
10/41. MRI features of toxoplasma encephalitis in the immunocompetent host: a report of two cases.central nervous system involvement due to toxoplasmosis in an immunocompetent host is rare. We describe MRI features in two immunocompetent patients with cerebral toxoplasmosis and compare these with those for the immunocompromised host.- - - - - - - - - - ranking = 0.19131224940308keywords = nervous system (Clic here for more details about this article) |
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