Daras M, Koppel B S, Samkoff L, Marc J
Department of Neurology, Metropolitan Hospital, New York Medical College, NY 10029.
J Neuroimaging. 1994 Apr;4(2):85-90. doi: 10.1111/jon19944285.
Brainstem involvement by Toxoplasma gondii is probably more common than other opportunistic infections, although it has not received adequate attention. Identification of toxoplasmosis is essential, as this condition responds to treatment with a significant increase in life expectancy. During the past 4 years, 366 AIDS patients with central nervous system toxoplasmosis diagnosed by biopsy or improvement following empirical treatment were evaluated. Among them, 8 (7 men, 1 woman; aged 25-55 yr) presented with signs of brainstem dysfunction. Six patients presented with an oculomotor nerve palsy and contralateral hemiplegia; 1 had an additional ipsilateral rubral tremor. The seventh patient had complete external ophthalmoplegia and the eighth had Parinaud's syndrome. Computed tomography revealed enhancing lesions in the brainstem of all patients. Seven responded to treatment with pyrimethamine and sulfadiazine.
尽管未得到充分关注，但弓形虫对脑干的侵袭可能比其他机会性感染更为常见。明确诊断弓形虫病至关重要，因为这种疾病经治疗后可显著延长患者寿命。在过去4年中，我们对366例经活检确诊或经经验性治疗后病情改善的艾滋病合并中枢神经系统弓形虫病患者进行了评估。其中，8例（7例男性，1例女性；年龄25 - 55岁）出现脑干功能障碍体征。6例患者表现为动眼神经麻痹及对侧偏瘫；1例还伴有同侧红核震颤。第7例患者出现完全性眼球外肌麻痹，第8例患者出现帕里诺德综合征。计算机断层扫描显示所有患者脑干均有强化病变。7例患者对乙胺嘧啶和磺胺嘧啶治疗有效。
