Pediatric acquired immunodeficiency syndrome. Neurologic syndromes
A. L. Belman, G. Diamond, D. Dickson, D. Horoupian, J. Llena, G. Lantos and A. Rubinstein
Department of Neurology, SUNY, Stony Brook 11794.
Central nervous system (CNS) dysfunction was documented in 61 of 68 infants
and children with symptomatic human immunodeficiency virus infection. The
most frequent manifestations included acquired microcephaly, cognitive
deficits, and bilateral pyramidal tract signs. Lymphoma of the CNS,
cerebrovascular accidents, and CNS infection caused by conventional
pathogens were documented in only ten children (15%). Neurologic
deterioration in 11 children was subacute but steadily progressive; in 31
the course was more indolent and began with a plateau. Of these 31
children, 13 had further neurologic deterioration and the conditions of
three improved. Seventeen children had a static course with cognitive
deficits (seven children) or cognitive plus neurologic impairment (ten
children). Neuroradiologic studies in the children with a subacute
progressive or plateau course disclosed cerebral atrophy, white matter
abnormalities, and calcification of the basal ganglia. Postmortem findings
included variable degrees of inflammatory response, multinucleated cells,
calcific vasculopathy, and pyramidal tract degeneration. Computed
tomographic studies of the children with a static course were normal or
showed mild atrophy, but poor brain growth was documented by serial head
circumference measurements.
