The neuropathologic study of 22 Brazilian cases of acquired immuno-deficiency syndrome (AIDS) was performed. Thirteen cases (59%) showed neuropathologic lesions. These included infection by Toxoplasma (n = 4), Cryptococcus neoformans (n = 3), viral encephalitis (n = 4), primary lymphomas (n = 2), isolated cerebral infarct (n = 1), and reactive gliosis (n = 1). In 2 cases, primary lymphoma and viral encephalitis were associated. Axonal spheroids in the gracilis and cuneatus nuclei were present in a case of toxoplasmosis. Mammillary bodies lesions consistent with Wernicke's encephalopathy were found in a case of viral encephalitis. In addition, circulatory changes (focal cortical infarcts) were associated lesions in 3 cases. These findings were compared with the main series reported in American and European literature.
PIP: Involvement of the central nervous system is not uncommon in patients with acquired immunodeficiency syndrome (AIDS). The neuropathologic aspects of 22 consecutive autopsies of Brazilian AIDS victims were investigated to gain more information on this manifestation. 13 (59%) of these cases exhibited neuropathologic changes, including infection by Toxoplasma (4 cases), Cryptococcus neoformans (3 cases), viral encephalitis (4 cases), primary lymphomas (2 cases), isolated cerebral infarct (1 case), and reactive gliosis (1 case). In 2 cases, primary lymphoma and viral encephalitis were associated. 3 of the 4 cases of toxoplasmosis had macroscopical abscesses in the region of the internal capsule, basal ganglia, or thalamus. Axonal spheroids in the gracilis and cuneatus nuclei were present. All 3 cryptococcosis cases demonstrated a meningeal inflammatory process; in addition, multiple microcysts were found in the cortex of the cerebral hemispheres and in the basal ganglia in 2 of these cases. The 4 encephalitis cases showed multiple microglial nodules and occasional foci of perivascular lymphocytic cuffings, with dissemination of lesions throughout the grey structures of the central nervous system. All 22 patients autopsied in this series were male; 19 were homosexual. Previous studies of the incidence of neurologic complications in AIDS reported in the US and European literature have yielded rates between 23-73%.