艾滋病伴发进行性多灶性白质脑病1例报道并文献复习

摘要

Objective To enhance the cognition and the clinical diagnostic rate of progressive multifocal leukoencephalopathy (PML) associated with AIDS. Methods One case of PML associated with AIDS was presented, including clinical symptoms, physical examination and radiological manifestations. Results The patient showed many advanced cerebral cortical functional defects, such as cognitive impairment, apraxia and aphasia; right hemiplegia and bilateral proprioceptive sense decrease; the protein level in cerebrospinal fluid was increased and the brain MRI showed high T2 signals in left frontal, parietal, temporal and right juncture of temporal and occipital lobes, with no mass effect or signal enhancement. Conclusions The manifestations of PML associated with AIDS vary significantly, mainly in the impairment of advanced cerebral cortical function.For young patients with subacute progression, we should consider the possibility of PML.%目的 提高临床对艾滋病伴发的进行性多灶性白质脑病(PML)的认识,以提高其临床诊出率.方法 分析1例临床诊断为艾滋病所致的PML患者的临床表现、体格检查及影像学资料.结果 患者神经系统表现为认知功能减退,失用、失读等高级皮层功能障碍,右侧偏瘫及双侧深感觉减退.脑脊液检查示蛋白升高,余未见明显异常.头部MRI检查示左侧额叶、顶叶、颞叶及右侧颞枕交界处多发T2高信号影,无占位效应,且病灶无强化.结论 艾滋病伴发的PML临床表现多种多样,多表现为高级皮层功能减退,对年轻、亚急性起病的患者应警惕此病的可能,以免误诊漏诊.