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Cerebellar disorders associated with HIV infection are typically the result of discrete cerebellar lesions resulting from opportunistic infections such as toxoplasmosis and progressive multifocal leukoencephalopathy or primary CNS lymphoma. Clinical symptoms and pathologic abnormalities related to the cerebellum may also be observed with HIV dementia. A primary cerebellar degeneration with HIV has not previously been reported. Ten patients were identified over an 8-year period at five med ical centers. All patients had clinical, laboratory, and radiologic evaluations, and three had neruopathologic examinations. Patients presented with progressively unsteady gait, slurred speech, and limb clumsiness. Examination revealed gait ataxia, imp aired limb coordination, dysarthria, and abnormal eye movements. Cognition, strength, and sensory function remained normal. CD4 lymphocyte counts varied between 10 and 437 cells/mm3. Neuroimaging studies showed prominent cerebellar atrophy. Neuropatho logy showed focal degeneration of the cerebellar granular cell layer and unusual focal axonal swellings in the brainstem and spinal cord. Cultures, histopathology, and immuno-chemical studies showed no conclusive evidence of infection. We report a syndr ome of unexplained degeneration of the cerebellum occurring in association with HIV infection. |
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acquired immunodeficiency syndrome
acquired immunodeficiency syndrome,heralded by neurologic invol
ataxia
ataxia,cerebellar
ataxic gait
cerebellar atrophy,secondary
cerebellar degeneration
cerebellar lesion
cerebellum
dysarthria
dysmetria
gait disorder
human immunodeficiency virus type 1
MRI
MRI,abnormal
neuropathology
walking,difficulty with
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