Kim Y S, Hollander H
Department of Medicine, University of California, San Francisco 94143-0378.
Clin Infect Dis. 1993 Jul;17(1):32-7. doi: 10.1093/clinids/17.1.32.
Neurological syndromes attributed to cytomegalovirus (CMV) in patients infected with human immunodeficiency virus (HIV) include encephalitis, myelitis, and peripheral neuropathy. More recently, polyradiculopathy due to CMV has been described. We review the literature and describe two patients with CMV polyradiculopathy whose conditions improved only after prolonged therapy with ganciclovir. Patients typically are young men who are severely immunocompromised and have had other opportunistic infections. The syndrome is characterized by subacute onset of leg weakness and numbness progressing to paraparesis or paraplegia. Bladder dysfunction is common. In many patients, CMV may be identified elsewhere; concomitant retinitis is common and often subclinical. Laboratory studies commonly show an increased number of neutrophils in CSF and hypoglycorrhachia. Electromyography and nerve conduction studies support the diagnosis. Imaging studies may be most useful to exclude spinal lesions. Without treatment prognosis is poor. Survival time is improved and symptoms often abate, sometimes dramatically, with ganciclovir therapy. Improvement of conditions may be rapid but can take months, as illustrated by these two cases. Once initiated, ganciclovir should be administered indefinitely to patients with CMV polyradiculopathy.
在感染人类免疫缺陷病毒（HIV）的患者中，由巨细胞病毒（CMV）引起的神经系统综合征包括脑炎、脊髓炎和周围神经病。最近，已有关于CMV所致多发性神经根病的描述。我们回顾了相关文献，并描述了两名患有CMV多发性神经根病的患者，他们仅在接受更昔洛韦长期治疗后病情才有所改善。患者通常为严重免疫功能低下且有其他机会性感染的年轻男性。该综合征的特征是腿部无力和麻木亚急性起病，逐渐发展为双下肢轻瘫或截瘫。膀胱功能障碍很常见。在许多患者中，CMV可能在其他部位被发现；合并视网膜病变很常见且往往为亚临床状态。实验室检查通常显示脑脊液中中性粒细胞数量增加和脑脊液糖含量降低。肌电图和神经传导研究有助于诊断。影像学检查对于排除脊柱病变可能最有用。未经治疗预后较差。使用更昔洛韦治疗可延长生存期，症状通常会减轻，有时会显著减轻，如这两个病例所示。病情改善可能很快，但也可能需要数月时间，这两个病例就是例证。一旦开始治疗，对于CMV多发性神经根病患者，更昔洛韦应无限期给药。
