Cirelli A, Ciardi M, Salotti A, Rossi F
Department of Infectious Diseases, University of Pisa, Italy.
Acta Neurol (Napoli). 1994 Jun;16(3):110-3.
The authors describe the first case in literature of Gerstmann's syndrome (agraphia, acalculia, finger agnosia) occurred in HIV correlated encephalopathy developed as the first severe manifestation of HIV infection in a patient with prevalent white matter neuroradiologic alterations. The PDL rapidly extended from the left subcortical parietal-occipital regions to the pre-rolandic one, with subsequent involvement of the corpus calosum splenium and the bilateral temporal lobes white matter. The authors indicate the extent of the lesions and the involvement of the interhemispheric connection fibres as the pathogenetic mechanism of the "Gerstmann syndrome", that until today has not been reported in the literature of the wide variety of AIDS dementia complex. The administration of 1 g of zidovudine for about 9 months did not avoid the establishing of the neurologic damage, but the sudden suspension of the drug could have enhanced the exacerbation of inflammation and the involvement of areas whose lesion is classically believed responsible for cognitive impairment.
作者描述了文献中首例格斯特曼综合征（失写症、失算症、手指失认症）发生于一名艾滋病相关脑病患者，该患者以白质神经放射学改变为主，而艾滋病相关脑病是其HIV感染的首个严重表现。病变从左侧皮质下顶枕区迅速扩展至运动前区，随后累及胼胝体压部和双侧颞叶白质。作者指出病变范围及半球间连接纤维受累是“格斯特曼综合征”的发病机制，而在大量艾滋病痴呆综合征的文献中，至今尚未有此报道。给予约9个月的1克齐多夫定治疗未能避免神经损伤的发生，但突然停药可能加剧了炎症恶化以及累及那些传统上认为其病变与认知障碍有关的区域。
