CHOREOATHETOSIS IN ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME PATIENTS WITH CEREBRAL TOXOPLASMOSIS

The aim of our study was to evaluate both the incidence and the pathol ogic and clinical features of extrapyramidal disorders in a population of acquired immune deficiency syndrome (AIDS) patients with cerebral toxoplasmosis. Of 240 AIDS patients evaluated in the 1985-1994 period. 50 of them were diagnosed to have cerebral toxoplasmosis on the basis of the following criteria: occurrence of specific antibodies, compute d tomography and/or magnetic resonance imaging (MRI), and regression o f the symptoms after specific therapy. Three of 50 (6%) had hemichoreo athetosis. In the first case, the disorder began as a dyskinesia of th e left hand that subsequently spread to the whole ipsilateral arm and assumed the features of choreic athetotic movements. The other two cas es were characterized by left hemisomatic distal choreic movements. Th erapy with pyrimethamine and sulfadiazine led to a complete recovery o f the extrapyramidal signs in two cases and to improvement in the thir d. According to our observations, the onset of these movement disorder s could not be related to the dimension of the lesion or to the edema, but to a specific localization in subthalamic nucleus, in subthalamic !pallidal, and pallidal/thalamic pathways. MRI seems the elective tool to perform a more accurate study of the anatomic areas involved in th is pathway and to verify their integrity. Cerebral toxoplasmosis in AI DS san be considered as a new etiopathogenic cause of choreoathetosis.