Guzmán-De-Villoria J A, Fernández-García P, Borrego-Ruiz P J
Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España; CIBER de Salud Mental (CIBERSAM), Madrid, España.
Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España.
Radiologia. 2017 Jan-Feb;59(1):2-16. doi: 10.1016/j.rx.2016.09.007. Epub 2016 Dec 21.
HIV-negative immunosuppressed patients comprise a heterogeneous group including transplant patients, patients undergoing treatment with immunosuppressors, uremic patients, alcoholics, undernourished patients, diabetics, patients on dialysis, elderly patients, and those diagnosed with severe or neoplastic processes. Epileptic seizures, focal neurologic signs, and meningoencephalitis are neurologic syndromes that require urgent action. In most of these situations, neuroimaging tests are necessary, but the findings can be different from those observed in immunocompetent patients in function of the inflammatory response. Infectious disease is the first diagnostic suspicion, and the identification of an opportunistic pathogen should be oriented in function of the type and degree of immunosuppression. Other neurologic emergencies include ischemic stroke, cerebral hemorrhage, neoplastic processes, and pharmacological neurotoxicity. This article reviews the role of neuroimaging in HIV-negative immunodepressed patients with a neurologic complication that requires urgent management.
HIV 阴性的免疫抑制患者是一个异质性群体，包括移植患者、接受免疫抑制剂治疗的患者、尿毒症患者、酗酒者、营养不良患者、糖尿病患者、透析患者、老年患者以及那些被诊断患有严重疾病或肿瘤性疾病的患者。癫痫发作、局灶性神经体征和脑膜脑炎是需要紧急处理的神经综合征。在大多数这些情况下，神经影像学检查是必要的，但根据炎症反应，其结果可能与免疫功能正常的患者不同。传染病是首要的诊断怀疑对象，应根据免疫抑制的类型和程度来确定机会性病原体。其他神经急症包括缺血性中风、脑出血、肿瘤性疾病和药物性神经毒性。本文综述了神经影像学在需要紧急处理的伴有神经系统并发症的 HIV 阴性免疫抑制患者中的作用。
