EXPANSION OF THE CEREBRAL-VENTRICLES AND CORRELATION WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME NEUROPATHOLOGY IN 232 PATIENTS

Background.-Expansion of the cerebral ventricles is highly prevalent i n patients with the acquired immunodeficiency syndrome (AIDS). The mec hanism remains unclear. The purpose of this study was to correlate the volume of the cerebral ventricles with histopathologic abnormalities in the brain. Methods.-At autopsy, the volume of the cerebral ventricl es in brain slices was estimated planimetrically in 232 patients with AIDS and 77 age-appropriate controls. Estimated volumes were compared with the neuropathologic results using multiple regression analysis. R esults.-Multiple regression analysis demonstrated a significant relati onship between ventricular volume and cerebral cytomegalovirus infecti on (P < .0004). When human immunodeficiency virus (HIV) encephalitis w ith multinucleated cells was present, median volume did not differ sig nificantly from other subjects with AIDS. in fl patients who had HIV-1 proviral DNA detected using the polymerase chain reaction, average vo lume was not different from 22 patients who tested negatively using po lymerase chain reaction. Ventricular expansion did not have a clear-cu t neuropathologic substrate in many instances. Conclusions.-In some su bjects with AIDS, cytomegalovirus encephalitis was the underlying neur opathologic lesion associated with ventricular expansion. Key indicato rs of brain HIV-1 infection were related either weakly or not at all, and the role of HIV-1 remains uncertain in most cases.