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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Case of Moyamoya Disease in a Patient With Advanced Acquired Immunodeficiency Syndrome
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Case of Moyamoya Disease in a Patient With Advanced Acquired Immunodeficiency Syndrome

机译：晚期获得性免疫缺陷综合症患者的烟雾病

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Background: Moyamoya disease is an occlusion of the terminal portion of internal carotid arteries and proximal portion of middle and anterior cerebral arteries of unknown origin. Moyamoya syndrome is associated with meningitis, tuberculosis, syphilis, head trauma, head irradiation, brain tumor, von Recklinghausen's disease, tuberous sclerosis, Marfan syndrome, sickle cell anemia, arteriosclerosis, hypertension, and oral contraceptive use. To our knowledge, acquired immunodeficiency syndrome (AIDS) as a cause of moyamoya syndrome has not been reported in an adult population. Objective: We report a case of moyamoya syndrome in a patient with AIDS and without other conditions associated with occlusion of the circle of Willis and formation of collateral network at the base of the brain and basal ganglia. Methods: We present a case report. Results: A 29-year-old woman with an 8-year history of AIDS on multiple antiretroviral medications presented with recurrent tingling of the left extremities which 1 monthlater progressed to mild hemiparesis and dysarthria. During the next few months the patient developed progressive cognitive decline and on-and-off fluctuations in the degree of hemiparesis. Brain magnetic resonance imaging showed multiple small subcortical infarct's in both parietal lobes. Magnetic resonance angiography showed occlusion of middle cerebral arteries distal internal carotid arteries, with prominent collateral network. Cerebral angiography confirmed moyamoya pattern. Lumbar puncture showed: white blood cell count 1, red blood cell count 418, protein 56, glucose 53, negative bacterial and acid-fast bacilli smear and culture, negative VDRL test, India ink, cryptococcal antigen, cytology and negative polymerase chain reaction for cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus type 1 and 2. Electroencephalography showed diffuse background slowing. Conclusions: We hypothesize that human immunodeficiency virus (HIV) caused central nervous system vasculitis, which eventually led to formation of moyamoya pattern. No other definite causes of central nervous system vasculitis were found in our patient. Cerebrovascular disorders should be considered in patients with HIV/AIDS with focal neurologic deficit. Moyamoya syndrome as a cause of stroke should be considered in patients with HIV/AIDS, especially as survival improves.
机译：背景：烟雾病是内源性颈动脉末端部分和中，前脑动脉近端部分的阻塞。 Moyamoya综合征与脑膜炎，肺结核，梅毒，头部创伤，头部放射，脑瘤，冯·雷克林豪森氏病，结节性硬化症，马凡氏综合征，镰状细胞性贫血，动脉硬化，高血压和口服避孕药有关。据我们所知，成年人群中未发现因烟雾病引起的后天免疫机能丧失综合症（AIDS）。目的：我们报道了一名艾滋病患者的烟雾病综合征，该患者没有其他与威利斯环的闭塞以及大脑和基底神经节的侧支网络形成有关的其他疾病。方法：我们提供一个病例报告。结果：一名29岁女性，有8年艾滋病史，曾接受多种抗逆转录病毒药物治疗，左肢反复发麻，此病1个月后发展为轻度偏瘫和构音障碍。在接下来的几个月中，患者出现进行性认知功能减退和偏瘫程度的开关波动。脑磁共振成像显示两个顶叶都有多个小的皮质下梗塞。磁共振血管造影显示大脑中动脉远端颈内动脉闭塞，并具有明显的侧支网络。脑血管造影证实烟雾纹。腰椎穿刺显示：白细胞计数1，红细胞计数418，蛋白质56，葡萄糖53，阴性细菌和抗酸杆菌涂片和培养，阴性VDRL测试，印度墨水，隐球菌抗原，细胞学和阴性聚合酶链反应巨细胞病毒，爱泼斯坦-巴尔病毒，水痘-带状疱疹病毒和1型和2型单纯疱疹病毒。脑电图显示弥散性背景变慢。结论：我们假设人类免疫缺陷病毒（HIV）引起中枢神经系统血管炎，并最终导致烟雾纹的形成。在我们的患者中未发现其他确定的中枢神经系统血管炎的病因。 HIV / AIDS伴有局灶性神经功能缺损的患者应考虑脑血管疾病。 HIV / AIDS患者应考虑将Moyamoya综合征作为中风的原因，尤其是随着生存率的提高。

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