Choreoathetosis in acquired immune deficiency syndrome patients with cerebral toxoplasmosis

Abstract

The aim of our study was to evaluate both the incidence and the pathologic and clinical features of extrapyramidal disorders in a population of acquired immune deficiency syndrome (AIDS) patients with cerebral toxoplasmosis. Of 240 AIDS patients evaluated in the 1985-1994 period, 50 of them were diagnosed to have cerebral toxoplasmosis on the basis of the following criteria: occurrence of specific antibodies, computed tomography and/or magnetic resonance imaging (MRI), and regression of the symptoms after specific therapy. Three of 50 (6%) had hemichoreoathetosis. In the first case, the disorder began as a dyskinesia of the left hand that subsequently spread to the whole ipsilateral arm and assumed the features of choreic athetotic movements. The other two cases were characterized by left hemisomatic distal choreic movements. Therapy with pyrimethamine and sulfadiazine led to a complete recovery of the extrapyramidal signs in two cases and to improvement in the third. According to our observations, the onset of these movement disorders could not be related to the dimension of the lesion or to the edema, but to a specific localization in subthalamic nucleus, in subthalamic/pallidal, and pallidal/thalamic pathways. MRI seems the elective tool to perform a more accurate study of the anatomic areas involved in this pathway and to verify their integrity. Cerebral toxoplasmosis in AIDS can be considered as a new etiopathogenic cause of choreoathetosis.

Late-onset cerebral toxoplasmosis after allogeneic bone marrow transplantation

“…2,3 Our patient presented with hemichoreoathetosis, a feature found in approximately 6% of patients with the acquired immunodeficiency syndrome (AIDS) and cerebral tox- oplasmosis. 6 Unlike the result in patients with AIDS, treatment did not improve the movement disorder in our patient.…”

“…3,4 These cytotoxic mechanisms may contribute to the pathophysiology of various complications following BMT that are associated with EC damage or malfunction. 5 There is increasing evidence that pretransplant conditioning regimens, including total body irradiation and cytotoxic chemotherapy, may contribute to an activation of the recipients' endothelium resulting in early inflammatory processes, 6 for example, through the increased expression of adhesion molecules and MHC complexes. Also, the conditioning-mediated influx of bacterial toxins like lipopolysaccharide (LPS) across damaged mucosal barriers can cre- ate an immunologically activated state.…”

Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso

“…Tais desordens podem ser a primeira manifestação de infecções oportunísticas, ou mesmo o sintoma inicial de SIDA 1,2,4,5 . São descritos HC-HB, mioclonia, tremor, acatisia, distonia e parkinsonismo [1][2][3][4][5][12][13][14] . A HC-HB é o distúrbio mais comum nestes pacientes, ao contrário de indivíduos sem infecção por HIV, em que tal quadro é muito mais raro 3 .…”

“…Navia et al revisaram os aspectos clínicos e neuropatológicos de 27 pacientes com SIDA e toxoplasmose cerebral, encontrando 2 casos com coréia 5 . Em estudo semelhante com amostra de 50 pacientes, Maggi et al encontraram 3 casos de hemicoreoatetose (6%) que responderam ao tratamento antiparasitário 13 . Nath et al relatam estudo de 7 pacientes com SIDA e distúrbio do movimento, 2 deles apresentando coréia secundária a toxoplasmose 2 .…”

“…Além disso, a notificação de que lesões em outras topografias dos núcleos da base além do núcleo subtalâmico podem produzir movimentos balísticos serviram para ampliar os conceitos da fisiopatologia da HC-HB. Neste particular, ressaltamos que a HC-HB pode estar relacionada a lesões do neoestriado e de vias subtálamo-palidais, estriado-palidais e pálido-talâmicas 13 . As lesões destes circuitos provocam uma redução da inibição do globo pálido externo (GPE), que determina excessiva atividade inibitória do GPE sobre o núcleo subtalâmico, reduzindo desta forma o seu tôno excitatório sobre o globo pálido interno(GPI), provocando redução da atividade inibitória dos gânglios da base e deste modo proporcionando o aparecimento de movimentos do tipo coréia e balismo 16 .…”