Brain Pathology Case of the Month - May 1998
CMV ventriculo-encephalitis, polyradiculitis, and multiple cranial neuritis
CMV has been associated with a variety of central (CNS) and peripheral (PNS) nervous system syndromes in AIDS patients. Among the PNS syndromes, a rapidly progressive lumbosacral polyradiculopathy is the most frequent, occurring in about 1% of AIDS patients (1-6). Cranial nerve involvement in this PNS CMV syndrome has been mentioned only rarely and only in occasional nerves (7,8). Our case is unique in the presence of multiple cranial neuropathies resulting from direct infection of each with CMV. The manifestations of CMV ventricular encephalitis are consistent with this previously described distinct clinical-pathological entity known to occur in HIV-infected patients (9). Another unique aspect in this case is the discrepancy between the minimal MRI findings in the periventricular regions in the presence of diffuse necrotizing ventriculo-encephalitis. A possible explanation for this is the fact that inflammation, which may be the primary reason for the abnormal MRI signal, in these areas was scarce.
In conclusion, the affinity of CMV for peripheral nerves also includes the cranial nerves. Thus, in an AIDS patient with cranial neuropathy and CSF polymorphonuclear pleocytosis, the diagnosis of CMV infection should be strongly considered.
Supported in part by a PHS grant PO1-NS27405.
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Contributed by Lawrence C. Kenyon, MD, PhD, Herbert I. Goldberg, MD, Dennis L. Kolson, MD, PhD, Ronald G. Collman, MD, and Ehud Lavi, MD