MICROGLIAL NODULAR ENCEPHALITIS AND VENTRICULOENCEPHALITIS DUE TO CYTOMEGALOVIRUS-INFECTION IN PATIENTS WITH AIDS - 2 DISTINCT CLINICAL-PATTERNS

In patients with AIDS, cerebral infection due to cytomegalovirus (CMV) results in two distinct neuropathological patterns: microglial nodula r encephalitis (MGNE) and ventriculo encephalitis (VE). In order to id entify clinical features to facilitate the differential diagnosis of t hese two forms of CMV encephalopathy in living patients, we retrospect ively reviewed the clinical records of 18 patients with MGNE or VE dia gnosed at autopsy. We identified the following clinical features as di stinguishing the two encephalopathies: (1) MGNE manifests earlier than VE; (2) the onset of MGNE is acute, whereas the onset of VE is insidi ous; (3) the onset of MGNE is marked by confusion and delirium, which do not occur in VE; (4) VE is frequently associated with radiculopathy , which is absent in MGNE; and (5) VE is associated with more marked a lterations in cerebrospinal fluid (high protein levels and pleocytosis ). The early neurological manifestations of MGNE should prompt a searc h for systemic CMV infection, which may lead to earlier treatment.