Hoyer Carolin, Alonso Angelika, Schlotter-Weigel Beate, Platten Michael, Fatar Marc
Department of Neurology, University Medical Centre Mannheim, Mannheim, Germany.
Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University Munich, Munich, Germany.
Case Rep Neurol. 2017 May 16;9(2):121-126. doi: 10.1159/000475544. eCollection 2017 May-Aug.
Apart from infectious causes and cerebellar dysfunction associated with acquired immune deficiency syndrome dementia or HIV-associated neurocognitive disorder, cerebellar dysfunction in HIV-positive individuals has been ascribed to granule cell neuronopathy as well as primary cerebellar atrophy without identifiable etiology. We report the case of a patient with progressive cerebellar dysfunction as the primary manifestation of HIV infection. No symptom improvement was seen under combination antiretroviral therapy, which had been established upon diagnosis, but the patient improved rapidly under 4-aminopyridine treatment, which was recommended 1 year later. Our report, adding to the rather small number of reports of HIV-associated cerebellar atrophy and dysfunction as a primary manifestation of HIV infection, draws attention to HIV as a possible differential etiology of a cerebellar syndrome. Further, rapid improvement of symptom severity under 4-aminopyridine treatment warrants further investigation with longer-term follow-up into the effectiveness of this compound in gait disorder associated with HIV infection.
除了与获得性免疫缺陷综合征痴呆或HIV相关神经认知障碍相关的感染性病因和小脑功能障碍外，HIV阳性个体的小脑功能障碍还归因于颗粒细胞神经元病以及病因不明的原发性小脑萎缩。我们报告了一例以进行性小脑功能障碍为HIV感染主要表现的患者。诊断后开始的联合抗逆转录病毒治疗未见症状改善，但1年后推荐的4-氨基吡啶治疗使患者迅速好转。我们的报告增加了作为HIV感染主要表现的HIV相关小脑萎缩和功能障碍的报告数量，提请注意HIV作为小脑综合征可能的鉴别病因。此外，4-氨基吡啶治疗后症状严重程度迅速改善，值得进一步研究该化合物对与HIV感染相关步态障碍的长期疗效。
