RESUMO
A 38-year-old man developed the Guillain-Barré syndrome (GBS) associated with untreated end-stage AIDS and CD4+ lymphocyte count of 3 cells/mm(3). The patient had serum high titer anti-sulfatide antibodies and responded well to infusion of immunoglobulin. The data suggest that elevated levels of anti-sulfatide antibodies may play a role in the pathogenesis of GBS in this patient, although a direct neurotropic effect of HIV virus cannot be excluded.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/patologia , Anticorpos/sangue , Linfócitos T CD4-Positivos/fisiologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/patologia , Sulfoglicoesfingolipídeos/imunologia , Adulto , Cromatografia em Camada Fina/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Humanos , Masculino , Condução Nervosa/fisiologia , Nervos Periféricos/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: Transesophageal echocardiography is used to detect the aortic arch pathology during diagnostic workup of ischemic stroke events. Conventional angiography is increasingly used in diagnosing and treating atherosclerotic vascular lesions in patients with ischemic stroke. Although catheter-based aortography can be performed with cerebral angiography, there is limited information about the utility of aortography in identifying atherosclerotic abnormalities of the aortic arch. METHODS: A retrospective chart review was performed to identify patients who underwent aortography as part of their angio-graphic study and transesophageal echocardiography. Both studies were reviewed independently in the absence of knowledge of the results of the other study. The findings of these aortograms were correlated with the findings of transesophageal echocardiography. RESULTS: A total of 34 patients underwent both aortography and echocardiography. Of a total of 34 trans esophageal echocardiograms, 29 showed abnormal findings in the aorta (85%) and 5 appeared normal (15%). These aortic abnormalities included mild to moderate atherosclerosis in 18 cases (52%), moderate to severe atherosclerosis in 4 cases (12%), and severe atherosclerosis in 7 cases (21%). None of these abnormalities were detected by aortography. No disease was visualized in the origin of the supraaortic arteries. CONCLUSIONS: Aortic arch atherosclerosis is common in patients with ischemic stroke; however, aortograms acquired during conventional angiography fail to identify abnormalities detected on transesophageal echocardiogram.