Huang P P, McMeeking A A, Stempien M J, Zagzag D
Department of Neurosurgery, New York University Medical Center, New York, USA.
Neurosurgery. 1997 May;40(5):1074-8; discussion 1078-9. doi: 10.1097/00006123-199705000-00037.
Although the differential diagnosis of intracranial lesions in patients who have tested positive for human immunodeficiency virus is extensive, toxoplasmosis, lymphoma, and progressive multifocal leukoencephalopathy comprise approximately 90% of such cases. Cytomegalovirus infection of the central nervous system may be difficult to diagnose and rarely presents as mass lesions revealed by radiographic studies.
Two patients who had tested positive for human immunodeficiency virus presented with progressive focal neurological deficits. Radiographic studies revealed solitary contrast-enhancing lesions in the right basal ganglia and right cerebellar hemisphere, respectively.
The first patient underwent a stereotactic biopsy but died despite appropriate therapy. The second patient died without tissue having been obtained for diagnosis. Postmortem examinations revealed necrotizing lesions with diffuse areas of infiltrating histiocytes containing eosinophilic cytomegalovirus inclusion bodies.
Although rare, cytomegalovirus infection should be considered in patients who have tested positive for human immunodeficiency virus and who present with enhancing intracranial lesions.
尽管人类免疫缺陷病毒检测呈阳性的患者颅内病变的鉴别诊断范围广泛，但弓形虫病、淋巴瘤和进行性多灶性白质脑病约占此类病例的90%。中枢神经系统巨细胞病毒感染可能难以诊断，很少表现为影像学检查发现的占位性病变。
两名人类免疫缺陷病毒检测呈阳性的患者出现进行性局灶性神经功能缺损。影像学检查分别显示右侧基底神经节和右侧小脑半球有单个强化病变。
第一名患者接受了立体定向活检，但尽管进行了适当治疗仍死亡。第二名患者未获得组织进行诊断就死亡了。尸检显示坏死性病变，伴有弥漫性浸润的组织细胞区域，其中含有嗜酸性巨细胞病毒包涵体。
尽管罕见，但对于人类免疫缺陷病毒检测呈阳性且出现颅内强化病变的患者，应考虑巨细胞病毒感染。
