Brain-stem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome.

Brain-stem auditory evoked potentials were recorded in 35 human immunodeficiency virus (HIV)-seropositive subjects from the Centers for Disease Control groups III and IV, 24 HIV-negative drug abusers, and 62 normal healthy controls. None of the patients had evidence of neurological complications. History of alcohol consumption was an exclusion criterion. The values of central conduction times I-V and III-V showed significant differences between the HIV-seropositive subjects and normal healthy controls, as well as between the HIV-seropositive subjects and HIV-negative drug abusers. Central conduction times I-III showed no differences between groups, except in the left ear of Centers for Disease Control group IV compared with controls. No statistical differences were found in the central conduction times between HIV-negative drug abusers and normal healthy controls. The results suggest a subclinical involvement of the upper brain stem in HIV infection. It could be produced by direct action of the virus on central nervous system structures.

Chagasic granulomatous encephalitis in immunosuppressed patients. Computed tomography and magnetic resonance imaging findings.

American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.

On the overlap between apathy and depression in dementia.

BACKGROUND: Whereas apathy is increasingly recognised as a frequent abnormal behaviour in dementia, its overlap with depression remains poorly understood. AIMS: To assess the psychometric characteristics of a structured interview for apathy, and to examine the overlap between apathy and depression in dementia. METHODS: A total of 150 patients with Alzheimer's disease (AD) underwent a comprehensive psychiatric and cognitive assessment. RESULTS: Twelve per cent of the sample met criteria for both apathy and depression, 7% met criteria for apathy only, and 31% met criteria for depression only. Apathy (but not depression) was significantly associated with more severe cognitive deficits. Apathy and anxiety scores accounted for 65% of the variance of depression scores in dementia, and the diagnosis of apathy had a minor impact on the rating of severity of depression. CONCLUSIONS: The Structured Interview for Apathy demonstrated adequate psychometric characteristics. Using a novel structured interview for apathy in AD we demonstrated that whereas the construct of depression primarily consists of symptom clusters of apathy and anxiety, apathy is a behavioural dimension independent of depression.

Cerebral tumor-like American trypanosomiasis in acquired immunodeficiency syndrome.

Cerebral tumor-like American trypanosomiasis (CTLAT) is an uncommon complication of Chagas' disease, observed only in immunosuppressed patients. We assessed 10 human immunodeficiency virus-positive patients with Chagas' disease who presented with CTLAT. All patients had neurological involvement and 6 developed intracranial hypertension. Neuroimaging studies showed supratentorial lesions in 9 patients, being single in 8. One case had infratentorial and supratentorial lesions. Low CD4+ cell counts were observed in all the cases and in 6 of them CTLAT was the first manifestation of acquired immunodeficiency syndrome. Serological tests for Chagas' disease were positive in 6 of 8 patients. Trypanosoma cruzi was identified in all brain specimens and in three cerebrospinal fluid samples. CTLAT should be considered in the differential diagnosis of intracranial mass lesions in human immunodeficiency virus-positive patients and should be added to the list of acquired immunodeficiency syndrome-defining illnesses.

Complicaciones neurológicas del síndrome de inmunodeficiencia adquirida / Neurological complications of AIDS

El compromiso del sistema nervioso en el SIDA puede producirse por dos mecanismos: a)como consecuencia de la inmunodepresión, por la que se genera la invasión de gérmenes oportunistas o neoplasias y b)por acción viral directa sobre las estructuras neurales. La acción viral directa sería el factor causal de la meningitis aséptica (observada durante el período de seroconversión) y de los trastornos cognitivos, motores y conductales (complejo SIDA-demencia) y la mielopatía observadas en el estadio lV del CDC. La agresión sobre la mielina de estructura subcorticales, tronco cerebral, cerebelo y médula constituirían el substrato anatomopatológico de estas manifestaciones tardías. Los cuadros más comunes vinculados a oportunistas son las encefalitis a citomegalovirus y herpéticas, la leucoencefalopatía multifocal progresiva, los cuadros focales secundarios o toxoplasmosis o tuberculomas y la meningitis criptocóccica. El tumor más común es el linfoma primario de cerebro, observándose con menos frecuencia la invasión por linfoma no Hodgkin o por el sarcoma de Kaposi. Las complicaciones neuromusculares son relativamente frecuentes tanto en el estadio asintomático como en el SIDA. El síndrome de Guillan Barré, observado especialmente durante la seroconversión, así como la polineuropatía inflamatoria desmielinizante crónica y la mononeuropatía múltiple observadas en el estadio asintomático son frecuentemente reportadas y no se diferencian esencialmente de cuadros similares en sujetos seronegativos. En el estadio lV del CDC es habitualmente observada la polineuropatía sensitiva distal, a la que puede asignársele valor de mercado evolutivo. La poliomiositis es el síndrome muscular más frecuente, siendo menos documentados la atrofia selectiva de fibras tipo ll y la miopatía nemalínica