Le lesioni encefaliche focali nel neuro-AIDS: Studio neuroradiologico multicentrico

Abstract

English

Vengono esposti i risultati di uno studio retrospettivo multicentrico di 52 pazienti, affetti da Neuro-AIDS, con lesioni TC encefaliche focali, di cui 24 a patogenesi nota, mediante esame del liquor, biopsia, autopsia e/o criterio ex iuvantibus (11 toxoplasmosi, 3 criptococcosi, 5 HIV, 4 Tbc, 1 Papovavirus). La sintomatologia neurologica era prevalentemente di tipo focale (28 casi), ma anche di AIDS-dementia-complex (17 casi), o di tipo meningitico o meningo-encefalitico (5). Tutti i casi sono stati studiati con TC con mezzo di contrasto endevenoso, prevalentemente con tecnica di doppia dose ritardata (DDD); 27, 16 ed 8 casi sono stati sottoposti rispettivamente a 2, 3, o 4 controlli TC. 6 pazienti sono stati studiati anche con RM (0,15 T), 2 con angiografia. Le lesioni focali erano singole nel 44%, multiple nel restante 56% (di cui 34% bilaterali), più frequentemente ipodense (eccetto un caso di toxoplasmosi emorragica iperdensa all'esame basale ed un caso di toxoplasmosi calcifica in un controllo) e 2/3 subivano un enhancement di tipo anulare, nodulare o misto. La sede più frequente era corticale e corticomidollare. In quasi 50% dei casi si associavano segni di atrofia superficiale e profonda. La RM in 2 casi (toxoplasmosi) ha dimostrato phi lesioni the la TC, in 4 ha evidenziato segni di interessamento della so-stanza bianca. In accordo con i dati della letteratura non vi sono caratteristiche specifiche di una infezione opportunistica o tumore AIDS-correlati, tuttavia lesioni focali multiple, rapidamente evolutive, con sintomatologia neurologica a focolaio sono più probabilmente (50%) toxoplasmosi.

La tecnica di enhancement DDD è obbligatoria per il riconoscimento del numero, e per la stadiazione delle lesioni focali. Nel campo delle lesioni focali ha indicazioni phi selettive (lesioni diffuse e/o della so-stanza bianca). Tuttavia i ruoli rispettivi di TC-DDD e RM nello studio del neuro-AIDS sono destinati a modificarsi entro breve tempo.

Keywords

AIDS Neuro-AIDS

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