Progressive Cerebellar Syndrome as the First Manifestation of HIV Infection

Puertas, Inmaculada; Jiménez‐Jiménez, Félix Javier; Gómez-Escalonilla, Carlos; Sayed, Youssef; Cabrera‐Valdivia, Francisco; Rojas, Raquel; Sanz-Moreno, José

doi:10.1159/000072515

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Several case reports describe cerebellar syndrome as a rare initial manifestation of HIV infection, and asymptomatic cerebellar atrophy has been reported in several neuroimaging studies of HIV (reviewed in Puertas et al, 2003). HIV enters the brain within 2 weeks of initial infection (Paul et al ., 2002), and damages neurons primarily by stimulating the production of cytokines that are toxic to neurons, leading to excitotoxic cell death, dendritic simplification and neuronal loss (Wiley et al, 1991).…”

Section: Discussionmentioning

confidence: 99%

Mapping cerebellar degeneration in HIV/AIDS

et al. 2008

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Progressive brain atrophy in HIV/AIDS is associated with impaired psychomotor performance, perhaps partly reflecting cerebellar degeneration, yet little is known about how HIV/AIDS affects the cerebellum. We visualized the 3D profile of atrophy in 19 HIV-positive subjects (age: 42.9+/− 8.3SD) versus 15 healthy controls (age: 38.5+/12.0). We localized consistent patterns of subregional atrophy with an image analysis method that automatically deforms each subject's scan, in 3D, to match a reference image. Atrophy was greatest in the posterior cerebellar vermis (14.9% deficit) and correlated with depression severity (p=0.009, corrected), but not with dementia, alcohol/substance abuse, CD4+ T-cell counts or viral load. Profound cerebellar deficits in HIV/AIDS (p=0.007, corrected) were associated with depression, suggesting a surrogate disease marker for antiretroviral trials.

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Section: Discussionmentioning

confidence: 99%

Mapping cerebellar degeneration in HIV/AIDS

et al. 2008

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“…Cerebellopontine degeneration has already been described in the setting of immune restoration following HAART therapy in a HIV patient 13 . Progressive cerebellar syndrome as the fi rst manifestation of HIV infection has already been described 14 . In this case, we believe that the HIV infection acted as a trigger for immune activation, leading to production of citokins and antibodies, which caused both CDeg and IPT.…”

Section: Discussionmentioning

confidence: 97%

Cerebellar degeneration and immune thrombocytopenic purpura associated with human immunodefi ciency virus infection (HIV)

Godeiro-Júnior

Felı́cio²,

Barsottini³

et al. 2007

Arq. Neuro-Psiquiatr.

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-Cerebellar disorders associated with HIV infection are usually caused by opportunistic infections, central nervous system lymphoma, and toxic effects of medicines, nutritional and metabolic disorders, and cerebrovascular disease. We present an unusual association of cerebellar degeneration and immune thrombocytopenic purpura in a 28-years-old woman HIV infected. An autoimmune aetiology is likely.KEY WORDS: HIV, autoimmunity, cerebelar degeneration, immune thrombocytopenic purpura.Degeneração cerebelar e púrpura trombocitopênica imunológica associados à infecção pelo vírus HIV RESUMO -Transtornos cerebelares associados a infecção pelo HIV são comumente causados por infecções oportunistas, linfoma do sistema nervoso central, efeitos tóxicos de medicamentos anti-retrovirais, alterações metabólicas e nutricionais, e doença cerebrovascular. Apresentamos um caso incomum de associação de degeneração cerebelar e púrpura trombocitopênica imunológica em um mulher de 28 anos infectada pelo HIV. Discutimos uma possível etiologia autoimune para justificar o quadro.PALAVRAS-CHAVE: autoimunidade, degeneração cerebelar, púrpura trombocitopênica imunológica.

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“…An HIV-associated isolated cerebellar syndrome in the absence of identifiable infectious, toxic and (para)neoplastic agents, and partly as the initial manifestation of the infection, has been described by several authors [ 2 , 3 , 4 , 7 , 8 , 9 , 10 ]. In some cases, JCV has been detected, and while earlier reports questioned the etiological significance of this finding [ 5 ], GCN was later proposed as a novel clinical entity underlying cerebellar granule cell destruction, sparing Purkinje cells and occurring either in isolation or in conjunction with PML lesions [ 1 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

HIV-Associated Cerebellar Dysfunction and Improvement with Aminopyridine Therapy: A Case Report

Hoyer¹,

Alonso²,

Schlotter‐Weigel³

et al. 2017

Case Rep Neurol

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Apart from infectious causes and cerebellar dysfunction associated with acquired immune deficiency syndrome dementia or HIV-associated neurocognitive disorder, cerebellar dysfunction in HIV-positive individuals has been ascribed to granule cell neuronopathy as well as primary cerebellar atrophy without identifiable etiology. We report the case of a patient with progressive cerebellar dysfunction as the primary manifestation of HIV infection. No symptom improvement was seen under combination antiretroviral therapy, which had been established upon diagnosis, but the patient improved rapidly under 4-aminopyridine treatment, which was recommended 1 year later. Our report, adding to the rather small number of reports of HIV-associated cerebellar atrophy and dysfunction as a primary manifestation of HIV infection, draws attention to HIV as a possible differential etiology of a cerebellar syndrome. Further, rapid improvement of symptom severity under 4-aminopyridine treatment warrants further investigation with longer-term follow-up into the effectiveness of this compound in gait disorder associated with HIV infection.

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Progressive Cerebellar Syndrome as the First Manifestation of HIV Infection

Cited by 7 publications

References 6 publications

Mapping cerebellar degeneration in HIV/AIDS

Mapping cerebellar degeneration in HIV/AIDS

Cerebellar degeneration and immune thrombocytopenic purpura associated with human immunodefi ciency virus infection (HIV)

HIV-Associated Cerebellar Dysfunction and Improvement with Aminopyridine Therapy: A Case Report

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