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AIDS-related MR hyperintensity of the basal ganglia
C C Meltzer1, S W Wells, M W Becher
1Department of Radiology, University of Pittsburgh Medical Center, Pa 15213, USA.
Purpose:
Our goal was to describe the MR imaging appearance and clinical pathologic correlates of bilateral basal ganglia hyperintensity in acquired immunodeficiency syndrome (AIDS).
Methods:
Medical records and laboratory data were reviewed retrospectively in nine cases of bilateral basal ganglia hyperintensity on long-repetition-time MR images. Opportunistic infections of the central nervous system were excluded by clinical and laboratory data. Postmortem neuropathologic examination was obtained in two cases.
Results:
All patients presented acutely with new seizures or changes in mental status. A history of drug abuse was elicited in seven of the nine remaining patients. Renal failure was present in six cases. Symmetric bilateral caudate and putamen hyperintensity on T2-weighted images was found in all cases with variable extension to the surrounding white matter, thalamus, and brain stem. Postmortem neuropathologic examination in two cases revealed numerous microinfarcts in a distribution similar to the MR signal abnormalities.
Conclusion:
The MR appearance of basal ganglia hyperintensity in this series of AIDS patients represents ischemic tissue injury. We propose that this clinicopathologic entity is precipitated by the combined effects of human immunodeficiency virus infection and drug use, particularly cocaine and/or associated toxic contaminants.
Insights
Bilateral basal ganglia hyperintensity on MRI in acquired immunodeficiency syndrome (AIDS) patients indicates ischemic injury. This condition is linked to human immunodeficiency virus (HIV) infection and drug use, particularly cocaine.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Acquired immunodeficiency syndrome (AIDS) can manifest with various neurological complications.
- Basal ganglia abnormalities on magnetic resonance (MR) imaging are observed in some AIDS patients.
- Understanding the imaging features and underlying pathology is crucial for diagnosis and management.
Purpose of the Study:
- To characterize the MR imaging findings of bilateral basal ganglia hyperintensity in patients with AIDS.
- To correlate these imaging findings with clinical and pathological data.
- To elucidate the potential causes of this specific MR imaging abnormality.
Main Methods:
- Retrospective review of medical records and laboratory data from nine AIDS patients with basal ganglia hyperintensity.
- Exclusion of opportunistic central nervous system infections.
- Neuropathologic examination in two postmortem cases.
Main Results:
- All patients presented with acute neurological symptoms like seizures or altered mental status.
- Symmetric hyperintensity in the caudate and putamen on T2-weighted MR images was consistently observed.
- Neuropathology revealed microinfarcts corresponding to the MR signal abnormalities.
Conclusions:
- The MR imaging pattern of basal ganglia hyperintensity in AIDS patients signifies ischemic tissue injury.
- This clinicopathologic entity is likely caused by the combined effects of HIV infection and drug use, including cocaine and its contaminants.