Ilniczky Sándor, Debreczeni Róbert, Kovács Tibor, Várkonyi Viktória, Barsi Péter, Szirmai Imre
Semmelweis Egyetem, Altalános Orvostudományi Kar, Neurológiai Klinika, Budapest.
Ideggyogy Sz. 2006 Jul 20;59(7-8):289-93.
The most frequent neurological manifestations of the Acquired Immunodeficiency Syndrome-(AIDS) are Cerebral Toxoplasmosis, Primary Central Nervous System Lymphoma (PCNSL), Progressive Multifocal Leukoencephalopathy (PML) and AIDS-encephalitis (AIDS-dementia complex, multinucleated giant cell encephalitis, HIV-encephalopathy). Neurological complications usually occur in the advanced stages of the disease, and they are uncommon in the beginning as presenting illness, but may result in life-threatening condition or in death. Rarely the disease presents as a neuropsychiatric illness in an undiagnosed AIDS patient, delaying a proper diagnosis. We present the case of a 34 years old patient treated for AIDS-related Toxoplasma-encephalitis in our department. His illness started as an acute psychosis followed by rapid mental and somatic decline, leading to death in three months. His HIV-seropositivity was not known at his admission, and the extraneural manifestations were slight. The diagnosis was established by serology, imaging methods and histopathological investigation. After presenting the medical history and results of autopsy studies of the patient we discuss the problems of the differential diagnosis, especially regarding the findings of the imaging methods.
获得性免疫缺陷综合征（艾滋病）最常见的神经学表现为脑弓形虫病、原发性中枢神经系统淋巴瘤（PCNSL）、进行性多灶性白质脑病（PML）和艾滋病脑炎（艾滋病痴呆综合征、多核巨细胞脑炎、HIV 脑病）。神经并发症通常发生在疾病晚期，起初作为首发疾病并不常见，但可能导致危及生命的状况或死亡。在未确诊的艾滋病患者中，该病很少以神经精神疾病的形式出现，从而延误正确诊断。我们报告一例 34 岁患者，在我们科室接受与艾滋病相关的弓形虫脑炎治疗。他的疾病始于急性精神病，随后精神和身体迅速衰退，三个月后死亡。入院时他的 HIV 血清阳性情况未知，且神经外表现轻微。通过血清学、影像学方法和组织病理学检查确诊。在介绍该患者的病史和尸检研究结果后，我们讨论鉴别诊断问题，尤其是关于影像学方法的检查结果。
