Radiological study of the brain at various stages of human immunodeficiency virus infection: early development of brain atrophy

Abstract

One hundred and one persons infected with human immunodeficiency virus (HIV-1), in whom other central nervous system infections or diseases were excluded, underwent brain CT and/or MRI at various stages of HIV-1 infection: 29 were asymptomatic (ASX), 35 had lymphadenopathy syndrome (LAS), 17 had AIDS-related complex (ARC), and 20 had AIDS. A control group of 32 HIV-1-seronegative healthy persons underwent brain MRI. The most common finding was brain atrophy, found in 9% of controls, and 31% of ASX cases, 29% of LAS, 59% of ARC and 70% of AIDS. Even the difference between the ASX or LAS groups and controls was significant. The changes were bilateral and symmetrical, and they were more severe at later stages of infection. Infratentorial atrophy was seen in the early stages; supratentorial atrophy became more pronounced at ARC, and generalized atrophy was typical of AIDS. Non-specific small hyperintense foci were found on MRI in 13% of controls and 6-15% of the infected groups. Larger, diffuse, bilateral white matter infiltrates were detected in 4 demented patients with AIDS. Four patients with AIDS and 1 with LAS had focal hyperintense lesions in the internal capsules, lentiform nuclei or thalamus, often bilateral on MRI. One patient with AIDS, examined with CT only, had low density in the lentiform nucleus. Loss of brain parenchyma can occur at an early stage of HIV-1 infection, and the atrophic process becomes more intense at later stages (ARC and AIDS). Parenchymal infiltration, seen as hyperintense areas on MRI, is most often associated with severe clinical symptoms, in the later stages of the disease.

Subcortical Profile of Memory Compromise Among HIV-1-Infected Individuals

“…Brain atrophy also appears to be specially pronounced in subcortical gray matter, such as the basal ganglia (Aylward et al, 1993;Dal Pan et al, 1992;Jakobson et al, 1989;Moeller & Backmund, 1990;Raininko et al, 1992). Hall et al (1996) measured the bicaudate ratios (BCR) and bifrontal ratios (BFR) of infected persons using magnetic resonance imaging (MRI), and abnormalities were seen in the corpus callosum, fornices, and lateral ventricles.…”

PET imaging of brain macrophages using the peripheral benzodiazepine receptor in a macaque model of neuroAIDS

“…While x-ray computed tomography has been considered relatively insensitive, magnetic resonance imaging (MRI) has demonstrated a spectrum of lesions including white matter abnormalities and brain atrophy in demented HIV-infected subjects (13)(14)(15)(16)(17)(18). Functional imaging studies using positron emission tomography (PET) with the fluorine-18-labeled glucose analogue [ 18 F]2-fluoro-2-deoxyglucose, single-photon emission computed tomography, magnetic resonance spectroscopy, and functional MRI have offered tantalizing insights into lentiviral infection, but no definitive relationship between abnormalities and onset of neurological disease has been observed (19)(20)(21)(22)(23).…”

A prospective radiologic and neurologic follow‐up study of 61 HIV‐1 ‐infected subjects: early beginning and slow progression of brain atrophy

“…Many magnetic resonance imaging (MRI) studies have illustrated large, diffuse whitematter infiltrates (Grant et d.. 1987;Post et al, 1988;Olsen et al, 1988;Chrysikopoulos et al, 1990;Raininko et al, 1992). Histologic changes compatible with HIV-1 -induced CNS disease have been found in these areas (Post et al, 1988;Olsen et al, 1988;Chrysikopoulos et al, 1990, Raininko er al., 1992.…”

“…Histologic changes compatible with HIV-1 -induced CNS disease have been found in these areas (Post et al, 1988;Olsen et al, 1988;Chrysikopoulos et al, 1990, Raininko er al., 1992. Atrophy, caused by HIV-I or other factors, is known to be the most frequent radiologic brain abnormality in patients with AIDS (Levy et Grafe et al, 1990;Flowers et al, 1990;Raininko et al, 1992;Gelman and Guinto, 1992). Brain atrophy has been reported even in asymptomatic HIV-1 infection (Raininko et af., 1992).…”