Sell M, Klingebiel R, Di Iorio G, Sampaolo S
Institute of Pathology, Vivantes Klinikum Neukölln, Charité Campus Mitte, Universitary Medicine, Berlin, Germany.
Clin Neuropathol. 2005 May-Jun;24(3):106-11.
We describe the clinical, radiological and neuropathological findings in an adult AIDS patient presenting with ventriculitis and hydrocephalus as the primary manifestations of cerebral toxoplasmosis. Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific. Cranial computed tomography showed a subtile ventricular dilatation whereas magnetic resonance imaging disclosed triventricular hydrocephalus due to stenosis of the aqueduct and a periventricular nodular rim of high signal intensity on T2- and proton density-weighted images. This rim also showed a slight enhancement on post-contrast T1-weighted images. Focal intracerebral lesions could not be delineated, neither by neuroimaging nor by pathology. Neuropathological examination showed severe ventriculitis with large ependymal and subependymal necrosis as well as dilatation of the lateral and the third ventricle. The only microorganism demonstrated at histology in the central nervous system was Toxoplasma gondii. We conclude that ventriculitis and hydrocephalus without any focal parenchymal lesion may be the only manifestations of CNS toxoplasmosis. It is important to recognize this unusual form of presentation of cerebral toxoplasmosis in order to perform specific therapy.
我们描述了一名成年艾滋病患者的临床、影像学和神经病理学表现，该患者以脑室炎和脑积水作为脑弓形虫病的主要表现。包括发热、头痛、精神状态改变和局灶性神经功能缺损在内的临床症状并无特异性。头颅计算机断层扫描显示脑室轻度扩张，而磁共振成像显示由于中脑导水管狭窄导致三脑室积水，在T2加权和质子密度加权图像上可见脑室周围有高信号强度的结节状边缘。该边缘在增强后T1加权图像上也有轻微强化。无论是神经影像学还是病理学检查均未发现局灶性脑内病变。神经病理学检查显示严重的脑室炎，伴有大量室管膜和室管膜下坏死以及侧脑室和第三脑室扩张。中枢神经系统组织学检查仅发现了刚地弓形虫。我们得出结论，无任何局灶性实质病变的脑室炎和脑积水可能是中枢神经系统弓形虫病的唯一表现。认识到脑弓形虫病这种不寻常的表现形式对于进行特异性治疗很重要。
