Cocaine can cause skull nerve damage

AIDS neurological damage

introduction

Introduction to the Neurological Damage of AIDS

AIDS (Acquired Immunodeficiency Syndrome), also known as Acquired Immunodeficiency Syndrome, is a contagious disease caused by the Human Immunodeficiency Virus (HIV). In 1981 the first AIDS patient was discovered in the US, and two patients were reported in China in 1989 and 1991. The AIDS patients are usually referred to as AIDS patients, and those who are not sick are infected with AIDS. Source of infection for damage to the nervous system. HIV is a neurotropic virus that enters the nervous system early, so the manifestation of AIDS in the central nervous system is mainly caused by direct HIV invasion. , Fungi and others prone to infection or secondary tumors, the combination of the two reasons above is more likely to suffer from disease.

Basic knowledge

The proportion of the disease: 0.001%

Vulnerable People: No specific people

Type of transmission: sexually transmitted mother-to-child transmission of blood transmission

Complications: multisystem organ failure

Pathogen

AIDS causes neurological damage

(1) causes of disease

HIV is one of the subfamilies of the retrovirus family of lentiviruses, including HIV-1 and HIV-2. HIV-1 is more potent and pathogenic than HIV-2 and is the major pathogenic microorganism. At present, HIV-2 infection in some West African countries is mainly restricted to AIDS patients and the mechanism of AIDS is still unclear. The HIV-1 virus itself and its metabolites have direct pathogenic effects. The main characteristic of HIV-1 activity is as follows: Genomic RNA is reverse transcribed into double-stranded DNA, which is then transferred into the host's nucleus and integrated into the host's chromosome by integrase to form a long-lasting structure. The body cannot remove them. It can remain stationary without any activity. High gene expression performance and active participation in virus production, HIV-1 also has neurotropic properties, can rely on mutations to obtain neurotropic specific variants, HIV can survive long-term survival in the central nervous system and be directly infected and cause a lot of damage at the same time, HIV- 1 does not always lead to cell death, so nerve tissue can be used as a place to store viruses.

(two) pathogenesis

The characteristic pathophysiological changes in AIDS are severe immunodeficiencies: HIV-1 binds to CD4-positive cells via a glycoprotein gp120 on its membrane, CD4 is a receptor for gp120 and mainly for CD4-positive cells in humans. Helper T cells (Th): After HIV-1 has entered the cell and continues to multiply, it is destroyed by the mechanism of apoptosis. This leads to a reversal of the Th / Ts ratio in the body, creating a serious immunodeficiency and harming the body. Many opportunistic infections and susceptibility to certain tumors increase and the patient eventually dies.

It has been confirmed that only blood, semen and cervical secretions can infect AIDS. So the main routes of transmission are: 1 sexual contact transmission, 2 blood transmission, 3 mother-to-child transmission, of which homosexual and intravenous drug addiction make up the vast majority.

prevention

AIDS neurological damage prevention

The main problem with AIDS is preventing infection: once the infection is severe, three main routes of transmission, such as sexual contact, blood transmission, and mother-to-child transmission, must be interrupted to reduce the incidence.

complication

AIDS complications in neurological damageComplications, Organ failure of several systems

As HIV is the causative agent of AIDS, once the body is infected, HIV damages the immune system and therefore causes opportunistic infections and tumors of various causes during the onset of the disease and the accompanying illnesses central nervous system, AIDS patients due to poor immune function, especially late, often not only a consequence of other diseases, but can also cause multiple organ failure (MOSF), secondary metabolic encephalopathy.

symptom

Symptoms of AIDS Neurological Damage CommonSymptoms Loss of appetite, high fever, nausea and vomiting, lymphadenopathy, diarrhea, convulsions, sensory disorders

HIV is a neurotropic virus that enters the nervous system early, so the manifestation of AIDS in the central nervous system is mainly caused by direct HIV invasion. Second, after HIV infection, the human immune mechanism becomes inhibited or the immune deficiency causes the virus, bacteria. , Fungi and others prone to infection or secondary tumors, the combination of the two reasons above is more likely to suffer from disease.

1. Primary Neurological Disorders of AIDS The central nervous system caused by HIV can be inflammatory, demyelinating, or degenerative, and some of them are considered definitive lesions of AIDS.

(1) Aseptic HIV meninges (brain) inflammation: In the early stages of AIDS, even the late stages, the patient's main symptoms are headache, fear of light, nausea, vomiting, fever, sore throat, loss of appetite, diarrhea, etc. There are obvious symptoms encephalitis, such as convulsions, aphasia, etc., often with generalized body stiffness - clonic seizures, lymphocytes in the CSF may increase, protein is increased, sugar is normal, EEG shows diffuse abnormalities, and some patients may experience cranial nerve paralysis, the most common is the facial nerve, followed by the trigeminal or auditory nerve.

(2) AIDS dementia syndrome: Formerly known as subacute or chronic HIV encephalitis, the most common clinical disease occurs in the late stage and is mainly characterized by progressive cognitive decline, inattention and memory loss, temporal and spatial disorientation, weakened motor skills, behavioral disorders, Difficulty walking due to ataxia and tremors, writing disorders, balance disorders, etc., such as involvement of the spinal cord, increased muscle tone, hyperreflexia, sensory disorder, in the late stage there may be loss of control of the bowel, behavior changes such as apathy, lack of interest, depression, silence, etc. come. As the disease progresses, the patient gradually develops towards plant survival. In contrast to dementia caused by poisoning or metabolic disorders, the symptoms mentioned above appear. It occurs under the condition of consciousness. There are no specific diagnostic criteria for this syndrome. It is very important to note the patient's slight cognitive decline. The head CT and MAI exams often show brain atrophy and the HIV virus is in the cerebrospinal fluid. Confirmed, there is no specific treatment for this syndrome.

(3) acute granulomatous cerebral vasculitis: extensive anterior, middle, posterior and proximal branches of the granuloma, inflammatory changes that cause the largest cerebral infarction, including basal ganglia, inner capsule, subcortical white matter, parietal lobe, and the occipital cortex and pons are covered, clinical Symptoms include high fever, mental symptoms, paroxysmal dysfunction, and corresponding focal symptoms. CT showed progressive brain atrophy and multiple low-density lesions, cerebrospinal fluid, and brain biopsy. III culture was positive, but blood culture and 3 HTLV-III antibodies in serum were negative, suggesting that the infection is confined to the central nervous system.

(4) Vacuolar myelopathy: Can occur alone or in combination with AIDS dementia syndrome, characterized by the discovery of vacuoles in the white matter of the spinal cord, penetrating mainly the lateral and posterior cords, with the thoracic vein being the most obvious and a similar phenomenon shows acute combined degeneration with progressive spastic paraplegia, ataxia and urinary incontinence, in some patients also vacuolar changes in the brain, clinical manifestations of progressive dementia.

(5) peripheral neuropathy (multiple radiculitis, polyneuritis, and neuropathy): Approximately 15% of AIDS cases with peripheral nerve damage, often manifesting as distal symmetrical sensory motor neuropathy, may have painful paresthesia. There is also chronic Guillain-Barre type neuropathy, some cases of subacute encephalopathy, normal cerebrospinal fluid or normal protein, electromyography with acromegaly, demyelination, and mild nerve conduction velocity.

2. The opportunistic infection of the central nervous system as a consequence of AIDS The central nervous system is the second organ besides the lungs that is susceptible to a conditional infection.

(1) Toxoplasmosis: Toxoplasma gondii is a protozoan in the cell that can cause multifocal, dispersed necrosis and inflammatory abscesses in the central nervous system. It is more common in the basal junction and a toxoplasma that lurks in the central nervous system. Reactivation can also occur in other immunosuppressive states that manifest as hypothermia, altered state of consciousness, convulsions, and localized signs. However, the symptoms and signs are not typical and need to be distinguished from other intracranial expansive lesions and lymphomas. Imaging findings of aggravated multiple ring lesions surrounded by edema and mass effects. Involvement of the basal nodules is the most common, and the serological diagnosis is often unspecific. However, a different diagnostic should be considered if the titer is <1: 4 and the MRI is most sensitive. However, it cannot be used for differential diagnosis: a brain biopsy can be diagnosed quickly, and pyrimethamine and sulfadiazine are supplemented with folic acid (to prevent anemia) daily, using hormones with caution as they can inhibit damaged immune function.

(2) Giant cell encephalitis and retinitis: the incidence is uncertain and clinical manifestations can be confused with HIV encephalitis. However, the disease progresses rapidly, with apparent periventricular inflammation, or with cytomegalovirus retinitis and whole body transmission. Symptoms of cerebral inflammation should be considered in the condition of sporadic infection; the degree of pathological changes varies from a small amount of inclusions of cytomegalovirus to obvious encephalitis and meningoencephalitis; biopsy may find evidence of the presence of viruses in the brain, but it is rarely isolated, cerebrospinal fluid culture is often negative, imaging exam shows white matter abnormalities around the ventricles, increased scanning may show cortical and subcortical lesions, giant cell retinitis is a common eye infection in AIDS patients, 20% of hemorrhagic retinitis, 60 % of bilateral, without treatment, can lead to blindness.

(3) Cryptococcus neoformans meningitis: The bacteria enter the body through the lungs and eventually reach the brain. This leads to clinical manifestations of progressive headache phenomena and impaired consciousness, accompanied by fever and epileptic seizures. CT findings are unspecific, mild to moderate ventricular dilatation, no meningeal enlargement, sometimes visible brain atrophy, granuloma, or abscess imaging. Diagnosis depends on the color of the CSF fluid to find pathogens. Early diagnosis can be treated with a combination of amphotericin B and 5-fluorocytosine.

(4) bacterial infection: it has been recognized that tuberculosis is the most common opportunistic infection in serum in HIV-1 positive patients and that its clinical manifestations are abnormal in patients with HIV and tuberculosis. Progress is accelerating, but tuberculosis is often innocent. Because of the weakened response, HIV patients do not have a significant increase in tuberculosis test. The type of extrapulmonary tuberculosis differs from that of general tuberculosis patients. Lymph node enlargement and miliary tuberculosis are the most common.

3. Tumor of the central nervous system as a result of AIDS

(1) Primary central nervous system lymphoma: Primary malignant central nervous system lymphoma is extremely rare. The incidence rate in the general population is estimated at 0.0001% and in AIDS patients at 2%. Primary Central Nervous System Lymphoma in the US There are approximately 225 cases per year, so the disease is becoming the major disease of AIDS patients. The tumor cells infiltrate the perivascular space of the brain parenchyma or the pia mater. The clinical manifestations are mostly subacute onset, mental changes, headache, confusion, eyesight. Obstruction, focal neurological dysfunction, etc., meningeal metastasis can show skull-nerve damage with multiple nerve-root damage, etc. CT shows deep brain, interstitial nodules, or ring-enlarged lesions around the ventricle that are difficult to identify in other tumors or infections, meningeal invasion may have meningeal thickening and amplification, usually requiring a brain biopsy to confirm the diagnosis has Recent practice has proven that the tumor is sensitive to radiation therapy, should it be active radiation therapy as soon as possible, it can extend the patient's survival.

(2) Kaposi's sarcoma: The most common malignant tumor in AIDS patients, but the central nervous system is rare. When the central nervous system is affected, it has been combined with another visceral involvement and extensive pulmonary metastasis. Clinically, there may be focal symptoms. Although the patient is sensitive to radiation and can easily be linked to a central nervous system infection, the patient eventually died of highly metastatic Kaposi's sarcoma.

4. Secondary cerebrovascular accident 10% to 20% of AIDS patients may have cerebrovascular accidents, the most common being multiple focal ischemic cerebral infarction, which can also manifest as hemorrhagic cerebral infarction, intratumoral hemorrhage, short-lived ischemic seizure and epidural, subdural hemoidal hemorrhage , Cerebral hemorrhage, etc. Recently, blood factors capable of causing a hypercoagulable condition have been isolated from the blood of some AIDS-infected persons, which may cause these young AIDS patients often cause ischemic cerebral infarction.

Investigate

AIDS neurological damage study

1. Detection of HIV antibodies The first expression of p24 antigen after HIV infection gradually disappears after a few weeks, but antibodies against the surface proteins of viruses such as p24 and gp41 gradually appear, and if an antibody is detected, it is assumed that a virus exists.

2. Antigen detection The ELISA double antibody sandwich method can detect the p24 antigen in serum and cerebrospinal fluid. The former is useful for determining the antigenemia of acute infection and the latter for diagnosing dementia syndrome.

3. PCR technology can detect traces of viral DNA, and the autoradiography method can also observe the presence of the virus.

4. The examination of cerebrospinal fluid includes smear staining, virus isolation and culture, the determination of the antigen-antibody titer and thus the determination of the type of infection and the virion.

5. Brain Biopsy In patients with suspected AIDS in the brain, CT and MRI can confirm the biopsy site and confirm the diagnosis.

6. CT scan is a widely used examination method. CT examination shows that around 35% of AIDS patients have simple brain atrophy, 25% focal brain damage, HIV encephalopathy and fungal meningitis have insect diseases (50% to 70%), others like primary central nervous system lymphoma (10% to 25%), progressive multifocal leukoencephalopathy (PML) (10% to 22%), low density If the enhancement is not obvious, it may be PML or primary lymphoma des Acting central nervous system, the lesion is limited to white matter, which suggests PML, the central nervous lymphoma may have a mass effect, there is ring reinforcement, in particular the lesion is located in the basal ganglia. The suggestion is toxoplasmosis; progressive brain atrophy is a complex dementia syndrome. After treatment, a CT scan can help monitor efficacy and prognosis.

7thMRI images are sensitive to early changes in brain disease, more accurate than a CT scan, especially if CT can only show a single lesion, MRI suggests more lesions, toxoplasmosis usually bilateral, multiple intracranial abnormalities when MRI can only cause the disease excluded if a single lesion is displayed.

8. EEG AIDS encephalopathy can show that the basic rhythm is slow (77 Hz), that toxoplasma lymphoma is mainly caused by focal changes, and that the EEG can be improved after treatment of the disease.

9. Other examinations may be based on different parts of the lesion using different examination methods such as electromyography, brain angiography, and other specialized examinations to aid in the diagnosis.

diagnosis

Diagnosis and diagnosis of AIDS neurological damage

Diagnostic criteria

The reporting criteria of the US Centers for Disease Control for AIDS are: Past health, no known potential factors other than HIV infection and cellular immunodeficiency that lead to concurrent opportunistic infections (Pneumocystis carinii or other specific opportunistic infections). Most often Kaposi's sarcoma), ie a complete AIDS infection in addition to an HIV infection caused by cellular immunodeficiency, patients must clinically diagnose one or more secondary diseases caused by cellular immunodeficiency manifest cellular immunodeficiency, e.g. Unexplained fever, insidious weight loss, severe oropharyngeal candidiasis, etc. However, there are no other diseases designated as secondary to Acquired AIDS-Related Complex (ARC) or pre-AIDS.

In 1990, the Chinese Ministry of Health's diagnostic criteria were:

1. The serum of the HIV-infected person is tested by a screening test such as an immunoenzymatic method or an indirect immunofluorescence test, and then confirmed by Western blot and other methods.

2. Confirmed cases

(1) HIV antibody positive and any of the following may be experimentally diagnosed AIDS patients:

1 Recent (3 to 6 months) weight loss of more than 10% and persistent fever above 38 ° C for at least 1 month.

2 Recently (3 to 6 months) weight loss of more than 10% and persistent diarrhea (3 to 5 times a day) more than 1 month.

3 Pneumocystis carinii pneumonia, Kaposi's sarcoma.

4 obvious fungal or other related pathogen infections.

(2) If the antibody positive person has symptoms of weight loss, fever, and diarrhea close to the above first standard and has any of the following symptoms, it may be an experimentally diagnosed AIDS patient:

The 1CD4 + / CD8 + lymphocyte count ratio was <1 and the CD4 + cell count was decreased.

2 lymph nodes.

3 obvious symptoms and signs of central nervous system lesions, obvious dementia, loss of discrimination, or motor neurologic dysfunction.

Differential diagnosis

1. Clinically, the differential diagnosis of encephalitis, spinal cord, nerves, and muscles should be carefully inquired about and the possibility of AIDS carefully identified.

2. The clinical manifestations of neurological diseases caused by AIDS are complex and changeable. Under certain circumstances, AIDS patients with toxoplasmosis, herpes simplex, tuberculosis, syphilis, etc. can be combined and more than two types of damage can occur, such as: AIDS dementia combined with myelopathy: AIDS patients may have similar symptoms with different types of lesions, e.g. B. in intracranial extensive lesions. You should have both toxoplasmosis, tuberculous granuloma, fungal granuloma, bacterial primary lymphosarcoma and the like.