[Clinical features of cerebral toxoplasmosis in Cuban patients with AIDS]

INTRODUCTION

Neurotoxoplasmosis (NTX) is one of the commonest opportunist infections in patients infected by the human immunodeficiency virus. It presents with a variety of clinical features in the immunocompromised patient.

PATIENTS AND METHODS

We made a horizontal retrospective descriptive study of 88 patients with a diagnosis of NTX treated in the Pedro Kour Institute during a three years period. Our aim was to find which were the most common forms of clinical presentation in our setting and to evaluate the use of paraclinical examinations in reaching the presumptive diagnosis. The patients had clinical examinations, CSF studies, detection of indirect immunofluorescence titres (IFI) for Toxoplasma, imaging studies (CAT) and lymphocyte counts.

RESULTS

The commonest symptoms were: headache in 79%, fever in 55.68%, motor defect in 44.31% and disorders of consciousness in 29.54% of the patients. The IFI titres were negative in 31.54% of the patients, between 1/16 and 1/32 in 38.34% and between 1/64 and 1/1,024 in only 30.07% of cases. The T CD4+ lymphocyte count was less than 200 cells in 66.7% of the patients; 72% of imaging studies showed typical lesions, in association with other disorders in 38% of the cases (lymphomas, cryptococcosis, tuberculous meningoencephalitis and cytomegalovirus encephalitis).

CONCLUSIONS

NTX in a patient with AIDS often presents in our setting with headache and fever, motor deficit and alterations of consciousness. The diagnosis should be confirmed by immunological or imaging studies since in this disease serology and CSF studies are less specific.

[Neurological Behcet syndrome. Presentation of three cases]

INTRODUCTION

Behçet's disease is a multisystemic illness in which neurological abnormalities are seen in 5-48% of cases.

CLINICAL CASES

We present 3 patients (2 men and 1 women) diagnosed as having Behçet's disease, according to the criteria of the 'International Study Group for Behçet's Disease' of 1990. We describe the clinical findings in these patients, the results of investigations done (MR or CT, evoked potentials-PEV, PESS, PEATC-EEG, ECN, CSF and neuropsychological tests), their course and response to treatment with hyperimmune human gammaglobulim at a dose of 400 mg/kg body weight in 2 patients. All three patients had repeated episodes of meningitis and alterations of the cranial nerves; two patients had epileptic seizures and two had signs of cerebellar disorders and dementia at some time during their illness. One patient died and the other two survived with severe disabilities. Cranial CT showed a cerebral infarct in one patient; evoked potentials showed axon damage in the two patients in whom this was studied. In the only patient in whom ECN was done, signs of axonal polyneuropathy were found. In all three patients there was pleocytosis in the CSF. In the patients in whom hyperimmune human gammaglobulin was given, the results were: one improved after this treatment; in the other there was clinical deterioration, but this was considered to be secondary to a curettage done the day before.

CONCLUSION

The presence of neurological findings in Behçet's disease not caused by cerebral vein thrombosis worsens the prognosis of these patients.

[Cardiovascular changes in a group of patients with heredoataxia. Clinical, electrocardiographic and echocardiographic findings]

INTRODUCTION

Heredoataxias form a group of degenerative diseases of the nervous system, which are progressive and hand sound in particular families.

MATERIAL AND METHODS

Between August 1994 and September 1995. 14 patients diagnosed as having heredoataxia were studied after admission to our hospital. Eight of these had Friedrich's ataxia (group A) and 6 had other types of ataxia (group B). A standard set of investigations were done, including clinical examination, laboratory tests (such as glycaemia and a lipidogram) to evaluate coronary risk factors. A 12 lead electrocardiogram and bidimensional and m mode echocardiogram were also done to detect disorders of conduction, changes in morphology and cardiac function, together with functional cardiovascular and neurological scales. The patients studied were between 14 and 41 years of age.

RESULTS

The most frequent cardiovascular symptom was dyspnoea of effort. Changes on the electrocardiogram were seen in 92% of the patients, mainly from Group A (100%) and were due to alterations of ventricular repolarization and non-specific alterations of conduction and of rhythm. Echocardiogram changes were found in 42.8% of the patients, most frequently due to an increase in the myocardial mass of the left ventricle.

CONCLUSIONS

Close correlation between age of onset and duration of the illness, and functional cardiovascular impairment was only seen in patients of Group A, in whom there was an earlier onset of the condition.

[Poems syndrome: a case report]

INTRODUCTION

The Poems syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammapathy and skin changes) is an uncommon multisystemic disorder. Usually it is a manifestation of a type of myeloma of which the chief characteristic is the presence of osteosclerotic lesions, classically seen radiologically to be single or multiple. Nowadays, not only is Poems considered to be a manifestation of osteosclerotic myeloma, but may also be seen associated with other plasma cell dyscrasias.

CLINICAL CASE

We present a case of Poems syndrome secondary to a plasmocytoma of the dorsal vertebral column in a 32 year old male negro. Initially he had sensori-motor polyneuropathy associated with other features characteristic of the syndrome (organomegaly, IgA monoclonal gammapathy and skin changes). Later he also showed signs attributed to a compressive lesion of the dorsal spinal medulla. An unusual finding in this patient was that the bony lesion was predominantly osteoclytic.

CONCLUSIONS

We briefly review the syndrome and comment on the diagnosis.