Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel.
AIDS Res Ther. 2014 Jan 21;11(1):4. doi: 10.1186/1742-6405-11-4.
Central nervous system involvement in AIDS patients can present at any stage of the disease. Brain lesions detected in imaging studies are usually treated empirically. A brain biopsy is indicated in the absence of clinical and radiologic improvement. In the present study, 16 AIDS patients underwent brain biopsy. We evaluated the diagnostic yield of the brain biopsy and the changes in the disease course.
Sixteen consecutive AIDS patients (12 men, 4 women; mean age 40.8 years) underwent a brain biopsy at Sheba Medical Center between 1997 and 2009. A retrospective analysis was performed and the clinical outcome was recorded.
Median CD4 count before biopsy was 62.6. Magnetic resonance images revealed multiple lesions in 12 patients and enhancing lesions in 12 patients. A total of 19 biopsies were performed in 16 patients. In the present series, the initial procedures provided a diagnostic yield of 81.25% (13 diagnostic cases from 16 procedures in 16 patients). Two of these patients underwent repeated biopsies that were eventually diagnostic . If repeated biopsies were taken into consideration, the diagnostic yield was 93.75% (15 diagnostic cases in 16 patients). The rate of hemorrhagic complications was 10.5% (2 hemorrhages in 19 procedures).Pathologic examination revealed parasitic and fungal infections in 6 patients (6/16; 38%), progressive multifocal leukoencephalopathy in 4 patients (4/16; 25%), AIDS encephalopathy in 4 patients (4/16; 25%), and lymphoma in 1 patient (1/16; 6%). One patient had a nonspecific inflammatory process (6%). The treatment modality was modified in 12 patients and led to clinical and radiologic improvement in 8 patients.
Brain biopsy should be considered when empiric treatment of central nervous system lesions in AIDS patients fails. Biopsy is diagnostic in the majority of patients. The diagnosis allows for treatment modifications, which lead to clinical and radiologic improvement in some patients.
艾滋病患者的中枢神经系统受累可发生在疾病的任何阶段。影像学检查中发现的脑病变通常采用经验性治疗。如果临床和影像学改善不明显，则需要进行脑活检。本研究对 16 例艾滋病患者进行了脑活检，评估了脑活检的诊断率和疾病进程的变化。
1997 年至 2009 年，在谢巴医疗中心对 16 例连续艾滋病患者（12 例男性，4 例女性；平均年龄 40.8 岁）进行了脑活检。对患者的临床结果进行回顾性分析。
活检前的中位 CD4 计数为 62.6。磁共振成像显示 12 例患者存在多发病变，12 例患者存在强化病变。在 16 例患者中，共进行了 19 次活检。在本系列中，首次活检的诊断率为 81.25%（16 例患者的 16 次活检中有 13 例诊断）。其中 2 例患者进行了重复活检，最终获得了诊断。如果将重复活检纳入考虑范围，诊断率为 93.75%（16 例患者中有 15 例诊断）。出血并发症发生率为 10.5%（19 次活检中有 2 次出血）。病理检查发现 6 例（6/16；38%）患者有寄生虫和真菌感染、4 例（4/16；25%）患者有多发性硬化性脑白质病、4 例（4/16；25%）患者有艾滋病性脑病、1 例（1/16；6%）患者有淋巴瘤、1 例（1/16；6%）患者有非特异性炎症过程。12 例患者的治疗方式进行了调整，其中 8 例患者的临床和影像学得到改善。
当经验性治疗艾滋病患者的中枢神经系统病变失败时，应考虑脑活检。活检对大多数患者具有诊断价值。诊断可以指导治疗方式的改变，从而使部分患者的临床和影像学得到改善。
