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Brain, Vol. 112, No. 1, 245-268, 1989
© 1989 Oxford University Press

research-article

CYTOMEGALOVIRUS IN THE NERVOUS SYSTEM OF PATIENTS WITH THE ACQUIRED IMMUNE DEFICIENCY SYNDROME

HARRY V. VINTERS1,, MICHAEL K. KWOK1, HECTOR W. HO1, KARL H. ANDERS2, UWAMIE TOMIYASU3, WILLIAM L. WOLFSON4 and FRANÇOISE ROBERT5

1Departments of Pathology, UCLA School of Medicine Los Angeles 2Kaiser-Permanente Hospital Woodland Hills 3Laboratory Services (Pathology), Wadsworth Veterans Administration Hospital Los Angeles 4Hoag Memorial Hospital Presbyterian Newport Beach, California, USA 5Department of Pathology, Sir Mortimer B. Davis Jewish General Hospital Montreal, Quebec, Canada

Correspondence to: Correspondence to: Dr Harry V. Vinters, Department of Pathology (Neuropathology), UCLA Medical Center, CHS 18-170, Los Angeles, California 90024-1732, USA

Clinicopathological features of infection of the nervous system by cytomegalovirus (CMV) in 31 patients with the acquired immune deficiency syndrome (AIDS) are reviewed. Neuropathology was variable, ranging from rare isolated CMV inclusions in brain without associated inflammation or necrosis, to severe necrotizing ependymitis and meningoencephalitis. In 1 patient, CMV had produced a necrotizing meningoradiculitis which presented clinically as ascending paralysis. In the brains and spinal cords of 6 patients, evidence of human immunodeficiency virus (HIV) infection of neural parenchyma was seen in close proximity to CMV infection. Both viruses individually or together were associated with low grade (microglial nodule) encephalitis. In retrospect, the diagnosis of CMV had been a difficult one to make clinically in neurologically impaired patients with AIDS. The results suggest that CMV may also localize in the nervous system without significant clinical sequelae. Imaging studies and analysis of cerebrospinal fluid revealed abnormalities in many patients, but none of them (short of culture of CMV itself in two cases) appeared to be specific to this neurological complication of the immunodeficiency.

Received January 7, 1988. Revised May 20, 1988. Accepted May 30, 1988.


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