garretto, N.S.; Bueri, J.A.; Kremenchutzky, M.; Consalvo, D.; Segura, M.; Genovese, O.

doi:10.1590/S0004-282X1995000100018

Resúmenes

Se observan complicaciones neurológicas en 40% de enfermos con SIDA. De estos, en 10% puede ser la manifestation inicial de la enfermedad. En otro 11% pueden aparecer trastornos del movimiento. Comunicamos el primer caso de hemicorea asociada a toxoplasmosis cerebral y SIDA en nuestro pais. Hombre de 26 anos, con diagnostico de SIDA y toxoplasmosis cerebral. Habia comenzado con crisis motoras simples de hemicuerpo izquierdo, con generalization secundaria y luego perdida de fuerza progresiva en dicho hemicuerpo. La RMN de cérebro mostro una lesion frontal derecha y otra temporo-occipital izquierda, con gran edema perilesional y efecto de masa. Las serologias para HIV y toxoplasmosis fueron positivas. Comenzo tratamiento con sulfadiazina y pirimetamina. Al duodecimo dia aparecieron movimientos involuntários dei pie izquierdo, coreicos, que se extendieron mas tarde a todo ese miembro inferior y luego al hemicuerpo. Nueva RMN de cérebro mostro disminucion dei edema y efecto de masa de las lesiones. Sin embargo, se observo una nueva lesion a nivel peduncular derecho. Movimientos involuntarios en pacientes con toxoplasmosis cerebral comenzaron a describirse recientemente solo en pacientes con SIDA. El presente seria el decimotercer caso de la literatura mundial y el primero en nuestro pais de hemicorea asociada a toxoplasmosis y SIDA.

SIDA (AIDS); toxoplasmosis cerebral; hemicorea

Only 12 AIDS cases with hemichorea were reported in the literature. We report the first case of hemichorea associated with AIDS and cerebral toxoplasmosis in our country. A 26-year-old man had 3 episodes of focal seizures on the left side with subsequent loss of consciousness. A few weeks later, he noticed progressive left-sided weakness. Examination revealed a left hemiparesis. MRI of the head showed a round mass in the right frontal lobe and a smaller lesion in the left temporo-occipital area. Laboratory showed positive serum ELISA and Western Blot analysis for HIV antibodies. Serum tests for Toxoplasma showed elevated titers. He was treated with pyrimethamine and sulfadiazine. His weakness improved and he had no further seizures. Two weeks later, choreic movements appeared in the left foot, finally involving the entire left hemibody. A second MRI showed a new small lesion in the right cerebral peduncle. The patient completed 6 weeks of treatment, with further reduction in the size of the lesions. Nevertheless, the left hemichorea persisted. We believe that the hemichorea our patient had was caused by the contralateral peduncular lesion. Lesions involving the subthalamic nucleus or its connections may cause contralateral hemiballismus or hemichorea. In spite of the favorable response to antitoxoplasmic therapy, the hemichorea persisted. The present report illustrates an uncommon neurological complication in AIDS. We believe that a combination of a focal cerebral lesion and the HIV infection caused the movement disorder presented by the patient.

AIDS; cerebral toxoplasmosis; hemichorea

Hemicorea asociada a toxoplasmosis cerebral y SIDA

Hemichorea in a patient with toxoplasmosis and AIDS

N.S. garretto; J.A. Bueri; M. Kremenchutzky; D. Consalvo; M. Segura; O. Genovese

Division y Catedra de Neurologia, Universidad de Buenos Aires: Hospital J. M. Ramos Mejia

RESUMEN

Se observan complicaciones neurológicas en 40% de enfermos con SIDA. De estos, en 10% puede ser la manifestation inicial de la enfermedad. En otro 11% pueden aparecer trastornos del movimiento. Comunicamos el primer caso de hemicorea asociada a toxoplasmosis cerebral y SIDA en nuestro pais. Hombre de 26 anos, con diagnostico de SIDA y toxoplasmosis cerebral. Habia comenzado con crisis motoras simples de hemicuerpo izquierdo, con generalization secundaria y luego perdida de fuerza progresiva en dicho hemicuerpo. La RMN de cérebro mostro una lesion frontal derecha y otra temporo-occipital izquierda, con gran edema perilesional y efecto de masa. Las serologias para HIV y toxoplasmosis fueron positivas. Comenzo tratamiento con sulfadiazina y pirimetamina. Al duodecimo dia aparecieron movimientos involuntários dei pie izquierdo, coreicos, que se extendieron mas tarde a todo ese miembro inferior y luego al hemicuerpo. Nueva RMN de cérebro mostro disminucion dei edema y efecto de masa de las lesiones. Sin embargo, se observo una nueva lesion a nivel peduncular derecho. Movimientos involuntarios en pacientes con toxoplasmosis cerebral comenzaron a describirse recientemente solo en pacientes con SIDA. El presente seria el decimotercer caso de la literatura mundial y el primero en nuestro pais de hemicorea asociada a toxoplasmosis y SIDA.

Palabras llave: SIDA (AIDS), toxoplasmosis cerebral, hemicorea.

SUMMARY

Only 12 AIDS cases with hemichorea were reported in the literature. We report the first case of hemichorea associated with AIDS and cerebral toxoplasmosis in our country. A 26-year-old man had 3 episodes of focal seizures on the left side with subsequent loss of consciousness. A few weeks later, he noticed progressive left-sided weakness. Examination revealed a left hemiparesis. MRI of the head showed a round mass in the right frontal lobe and a smaller lesion in the left temporo-occipital area. Laboratory showed positive serum ELISA and Western Blot analysis for HIV antibodies. Serum tests for Toxoplasma showed elevated titers. He was treated with pyrimethamine and sulfadiazine. His weakness improved and he had no further seizures. Two weeks later, choreic movements appeared in the left foot, finally involving the entire left hemibody. A second MRI showed a new small lesion in the right cerebral peduncle. The patient completed 6 weeks of treatment, with further reduction in the size of the lesions. Nevertheless, the left hemichorea persisted. We believe that the hemichorea our patient had was caused by the contralateral peduncular lesion. Lesions involving the subthalamic nucleus or its connections may cause contralateral hemiballismus or hemichorea. In spite of the favorable response to antitoxoplasmic therapy, the hemichorea persisted. The present report illustrates an uncommon neurological complication in AIDS. We believe that a combination of a focal cerebral lesion and the HIV infection caused the movement disorder presented by the patient.

Key words:AIDS, cerebral toxoplasmosis, hemichorea.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 15-setembro-1994.

Dra. Nelida Susana Garretto - Division Neurologia, Hospital J. M. Ramos Mejia - Urquiza 609 - 1221 Buenos Aires - Argentina.

Referencias bibliográficas

1. Berger JR, Moskowitz L, Fischl M et al. Neurologic disease as the presenting manifestation of acquired immunodeficiency syndrome. South Med J 1987, 80: 683-686.
2. Bredesen DE, Messing R. Neurological syndromes heralding the acquired immunodeficiency syndrome [Abstract]. Ann Neurol 1983, 14: 141.
3. Ciricillo SF, Rosenblum ML. Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 1990, 73: 720-724.
4. Crossman AR. A hypothesis on the pathophysiological mechanisms that underlie levodopa or dopamine agonist induced dyskinesia in Parkinson's disease: implication for future strategies in treatment. Mov Disord 1990, 5: 100-108.
5. Edelstein H, Knight RT. Severe parkinsonism in two AIDSpatients taking prochlorperazine. Lancet 1987, 2: 341-342.
6. Hollander H, Golden J, Mendelson T, Cortland D. Extrapyramidal symptoms in AIDS patients given low dose methoclopramide or chlorpromazine. Lancet 1985, 2: 1186.
7. Kieburtz KD, Epstein LG, Gelbard HA, Greenamyre JT. Excitotoxicity and dopaminergic dysfunction in the acquired immunodeficiency syndrome dementia complex. Arch Neurol 1991, 48: 1281-1284.
8. Koppel BS. Neurological complications of AIDS and HIV infection: an overview. In Wormser GP (ed). AIDS and other manifestations of HIV infection. Ed 2. New York Raven Press 1992, p 31S-348.
9. Krauss JK, Collard M, Mohadjer M et al. Hemiballism as the first symptom of AIDS: case report. Nervenarzt 1990, 61: 510-515.
10. McLeod R, Berry PF, Marshall WM, Hunt SA, Ryning FW. Toxoplasmosis presenting as brain abscesses: diagnosis by computerized tomography and cytology of aspirated purulent material. Am J Med 1979, 67: 711-714.
11. Nath A, Jankovic J, Pettigrew C. Movement disorders and AIDS. Neurology 1987, 37: 37-41.
12. Nath A, Hobson DE, Russell A. Movement disorders with cerebral toxoplasmosis and AIDS. Mov Disord 1993, 8: 107-112.
13. Navia BA, Petito CK, Gold JWM et al. Cerebral toxoplasmosis complicating the acquired immunodeficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19: 224-238.
14. Pestre P, Milandre L, Farnarier P, Gallais H. Hemichorea with toxoplasmosis abscess of the striatum in patients with AIDS. Rev Neurol (Paris) 1991, 147: 833-837.
15. Rottemberg DA, Meoller JR, Strother CS. The metabolic pathology of the AIDS dementiacomplex. Ann Neurol 1987, 22: 700-706.
16. Sanchez-Ramos JR, Factor SA, Weiner WJ, Marquez J. Hemichoreahemiballismus associated with acquired immunodeficiency syndrome and cerebral toxoplasmosis. Mov Disord 1989, 4: 266-273.
17. Slavick HE, Lipman IJ. Brain stem toxoplasmosis complicating Hodgkin's disease. Arch Neurol 1977, 34: 636-637.
18. Tedrus GMA, Albertin MC, Fonseca LC. Hemibalismo como manifestacao inicial da sindrome de imunodeficiencia adquirida. Arq Neuropsiquiatr 1994, 52: 263-26S.

Fechas de Publicación

Publicación en esta colección
19 Ene 2011
Fecha del número
Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Berger JR, Moskowitz L, Fischl M et al. Neurologic disease as the presenting manifestation of acquired immunodeficiency syndrome. South Med J 1987, 80: 683-686.

[2] 2. Bredesen DE, Messing R. Neurological syndromes heralding the acquired immunodeficiency syndrome [Abstract]. Ann Neurol 1983, 14: 141.

[3] 3. Ciricillo SF, Rosenblum ML. Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 1990, 73: 720-724.

[4] 4. Crossman AR. A hypothesis on the pathophysiological mechanisms that underlie levodopa or dopamine agonist induced dyskinesia in Parkinson's disease: implication for future strategies in treatment. Mov Disord 1990, 5: 100-108.

[5] 5. Edelstein H, Knight RT. Severe parkinsonism in two AIDSpatients taking prochlorperazine. Lancet 1987, 2: 341-342.

[6] 6. Hollander H, Golden J, Mendelson T, Cortland D. Extrapyramidal symptoms in AIDS patients given low dose methoclopramide or chlorpromazine. Lancet 1985, 2: 1186.

[7] 7. Kieburtz KD, Epstein LG, Gelbard HA, Greenamyre JT. Excitotoxicity and dopaminergic dysfunction in the acquired immunodeficiency syndrome dementia complex. Arch Neurol 1991, 48: 1281-1284.

[8] 8. Koppel BS. Neurological complications of AIDS and HIV infection: an overview. In Wormser GP (ed). AIDS and other manifestations of HIV infection. Ed 2. New York Raven Press 1992, p 31S-348.

[9] 9. Krauss JK, Collard M, Mohadjer M et al. Hemiballism as the first symptom of AIDS: case report. Nervenarzt 1990, 61: 510-515.

[10] 10. McLeod R, Berry PF, Marshall WM, Hunt SA, Ryning FW. Toxoplasmosis presenting as brain abscesses: diagnosis by computerized tomography and cytology of aspirated purulent material. Am J Med 1979, 67: 711-714.

[11] 11. Nath A, Jankovic J, Pettigrew C. Movement disorders and AIDS. Neurology 1987, 37: 37-41.

[12] 12. Nath A, Hobson DE, Russell A. Movement disorders with cerebral toxoplasmosis and AIDS. Mov Disord 1993, 8: 107-112.

[13] 13. Navia BA, Petito CK, Gold JWM et al. Cerebral toxoplasmosis complicating the acquired immunodeficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19: 224-238.

[14] 14. Pestre P, Milandre L, Farnarier P, Gallais H. Hemichorea with toxoplasmosis abscess of the striatum in patients with AIDS. Rev Neurol (Paris) 1991, 147: 833-837.

[15] 15. Rottemberg DA, Meoller JR, Strother CS. The metabolic pathology of the AIDS dementiacomplex. Ann Neurol 1987, 22: 700-706.

[16] 16. Sanchez-Ramos JR, Factor SA, Weiner WJ, Marquez J. Hemichoreahemiballismus associated with acquired immunodeficiency syndrome and cerebral toxoplasmosis. Mov Disord 1989, 4: 266-273.

[17] 17. Slavick HE, Lipman IJ. Brain stem toxoplasmosis complicating Hodgkin's disease. Arch Neurol 1977, 34: 636-637.

[18] 18. Tedrus GMA, Albertin MC, Fonseca LC. Hemibalismo como manifestacao inicial da sindrome de imunodeficiencia adquirida. Arq Neuropsiquiatr 1994, 52: 263-26S.