Related Experiment Videos
Microglial nodular encephalitis and ventriculoencephalitis due to cytomegalovirus infection in patients with AIDS:
M P Grassi1, F Clerici, C Perin
1I Clinica Neurologica, Clinica di Malattie Infettive, Anatomia Patologica-Istituto di Scienze Biomediche, Milano, Italy.
Abstract:
In patients with AIDS, cerebral infection due to cytomegalovirus (CMV) results in two distinct neuropathological patterns: microglial nodular encephalitis (MGNE) and ventriculoencephalitis (VE). In order to identify clinical features to facilitate the differential diagnosis of these two forms of CMV encephalopathy in living patients, we retrospectively reviewed the clinical records of 18 patients with MGNE or VE diagnosed at autopsy. We identified the following clinical features as distinguishing the two encephalopathies: (1) MGNE manifests earlier than VE; (2) the onset of MGNE is acute, whereas the onset of VE is insidious; (3) the onset of MGNE is marked by confusion and delirium, which do not occur in VE; (4) VE is frequently associated with radiculopathy, which is absent in MGNE; and (5) VE is associated with more marked alterations in cerebrospinal fluid (high protein levels and pleocytosis). The early neurological manifestations of MGNE should prompt a search for systemic CMV infection, which may lead to earlier treatment.
Insights
Cytomegalovirus (CMV) encephalitis in AIDS patients presents as microglial nodular encephalitis (MGNE) or ventriculoencephalitis (VE). Differentiating these CMV brain infections relies on distinct clinical features and cerebrospinal fluid analysis for timely treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Cytomegalovirus (CMV) infection is a significant opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
- CMV can cause distinct cerebral infections, leading to neuropathological patterns of microglial nodular encephalitis (MGNE) and ventriculoencephalitis (VE).
- Distinguishing between MGNE and VE in living patients is challenging but crucial for appropriate management.
Purpose of the Study:
- To identify distinct clinical features that differentiate MGNE from VE in patients with AIDS.
- To facilitate the early and accurate diagnosis of CMV encephalopathy in immunocompromised individuals.
Main Methods:
- Retrospective review of clinical records from 18 patients diagnosed with MGNE or VE at autopsy.
- Analysis of clinical presentations, onset patterns, neurological symptoms, and cerebrospinal fluid (CSF) findings.
Main Results:
- MGNE typically manifests earlier and with an acute onset, often presenting with confusion and delirium.
- VE exhibits an insidious onset and is frequently associated with radiculopathy and more pronounced CSF abnormalities (elevated protein and pleocytosis).
- MGNE and VE show distinct clinical trajectories and diagnostic markers.
Conclusions:
- Clinical features, including onset, specific neurological symptoms, and CSF analysis, can effectively differentiate MGNE and VE.
- Early recognition of MGNE's neurological manifestations should prompt investigation for systemic CMV infection, enabling prompt therapeutic intervention.