Early brain atrophy in HIV infection: a radiological-stereological study

Abstract

Patients with the acquired immunodeficiency syndrome (AIDS) frequently develop neurological abnormalities, and atrophy has been reported in neuropathological studies of brains from patients with AIDS. Our aim was to see whether increased ventricular volume, indicating central cerebral atrophy develops at an early stage of HIV-infection, before patients are severely immunodeficient. We also wished to follow ventricular size over time and to investigate whether enlargement would be more marked in patients, who became clinically demented. We studied 32 HIV-seropositive men who had several CT studies. At the time of the first CT the patients were divided into two groups, an immunocompetent group (IC) with CD4 cell count >400 and an immunodeficient group (ID) with CD4 cell count <400. These were compared with a control group of 44 seronegative men. Subsequent CT studies were used to measure changes in ventricular size with time. Ventricular volume was estimated with an unbiased stereological method previously applied to CT. Mean (geometric) ventricular volume was 15 ml (6-54 ml) in the controls, 23 ml (10-72 ml) in the IC group and 27 ml (8-80 ml) in the ID group. The increase in size in both patient groups was statistically significant compared with controls: P=0.005 (IC) and 9 x 10(-5)(ID). Regression analysis of the follow-up CT studies showed a significant increase in volume in the HIV group (r=0.74, P=0.002), but not in the AIDS group (r=0.41, P<0.1).

Stereological estimation of total intracranial volume on CT images

“…Several studies have reported that the application of a stereological technique on CT scans may provide unbiased organ volume estimations [15][16][17][18][19][20][21]. Van der Worp et al have performed stereological assessments of the intracranial cavity volume [21].…”

Behavioral Changes in Aids Patients in Co-Relation With The Cd4 Count and Ct Findings in Brain

“…The changes are like HIV-encephalitis, diffuse white matter pallor called HIV-Leukoencephalopathy reecting loss of blood-brain barrier or involvement of grey matter called Diffuse Poliodystrophy with neuronal loss will result in programmed cell death (apoptosis), myelin loss or axonal damage [8,9]. The loss of brain tissue will lead to cortical thinning and increased in ventricular volume of brain [10,11]. The changes are very much diagnostic by CT or MRI.…”

Torus Palatinus: estudo por Tomografia Computadorizada".

“…(JERNIGAN et al, 1993;CIVITELLO et al, 1999). A RM com espectroscopia pode ser útil nestas investigações como um marcador precoce das manifestações clínicas, além de fornecer dados objetivos para a mensuração da eficácia dos tratamentos (PAVLAKIS et al, 1998) JERNIGAN et al, 1993;KORBO et al, 2002).…”

“…Atualmente, os estudos têm dado uma atenção especial à associação entre as alterações da substância branca e a atrofia, acima descrita (KORBO et al, 2002;PATEL et al, 2002).…”

“…Dentre as considerações relacionadas com o processo nosológico e do desenvolvimento adquirido durante a realização deste estudo evolutivo, destacam-se o surgimento e a adoção de novas opções terapêuticas para estes pacientes (TOZZI et al, 1999;LAUFER;SCOTT, 2000;GERACI;SIMPSON, 2001), e a melhoria técnica dos procedimentos diagnósticos laboratoriais, como o surgimento da técnica de PCR (CIVITELLO et al, 1999;SIGNORE et al, 2000;TOSCHI et al, 2001), além das novas técnicas de neuroimagem (THURNHER et al, 2000;AVISON, 2001;FILIPPI et al, 2001;BELMAN, 2002;KORBO et al, 2002;PATEL et al, 2002).…”