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Biomedical subjects

M A Pagano

Publications and source records attributed to M A Pagano.

14 recordsLinked to original sources
PubMed1999

Cerebral tumor-like American trypanosomiasis in acquired immunodeficiency syndrome.

Cerebral tumor-like American trypanosomiasis (CTLAT) is an uncommon complication of Chagas' disease, observed only in immunosuppressed patients. We assessed 10 human immunodeficiency virus-positive patients with Chagas' disease who presented with CTLAT. All patients had neurological involvement and 6 developed intracranial hypertension. Neuroimaging studies showed supratentorial lesions in 9 patients, being single in 8. One case had infratentorial and supratentorial lesions. Low CD4+ cell counts were observed in all the cases and in 6 of them CTLAT was the first manifestation of acquired immunodeficiency syndrome. Serological tests for Chagas' disease were positive in 6 of 8 patients. Trypanosoma cruzi was identified in all brain specimens and in three cerebrospinal fluid samples. CTLAT should be considered in the differential diagnosis of intracranial mass lesions in human immunodeficiency virus-positive patients and should be added to the list of acquired immunodeficiency syndrome-defining illnesses.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Focal dystonia and tremor secondary to brain stem tuberculoma].

Brainstem tuberculoma is exceptionally observed. We report a 44 year-old immunocompetent man with proven diagnosis of miliary tuberculosis (TBC) who developed a complex neurological syndrome characterized by right ophtalmoplegia, left-sided hemiparesis and hemihypoesthesia and a gross ipsilateral postural and action tremor with hand dystonia. A ponto-mesencephalic mass was detected by CT and MRI studies of the brain. Clinical, bacteriological and neuroimaging studies allowed to suspect a ponto-mesencephalic tuberculoma. Long-term therapy with anti-TBC drugs and steroids was started, achieving clinical and imaging improvement which retrospectively confirmed the diagnosis. Although with less amplitude, tremor persisted but a complete disappearance of focal dystonia was observed. The pathogenesis of both abnormal movements is particularly discussed since hand dystonia has never been mentioned in the literature as a consequence of brainstem damage.

Adult↗
PubMed1996

Chagasic granulomatous encephalitis in immunosuppressed patients. Computed tomography and magnetic resonance imaging findings.

American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.

AIDS-Related Opportunistic Infections↗
PubMed1994

HIV-encephalopathy: should we await a catastrophe before screening?

Human Immunodeficiency Virus (HIV)-encephalopathy (formerly AIDS Dementia Complex, or ADC) is characterized by global impairment of intellectual and cognitive functions, personality and behavioral disturbances, decreased memory, inability to concentrate, and apathy. Its motor dysfunction is manifested by impaired speech, gait, and coordination, and by psychomotor retardation. Several scientific reports indicate that ADC may be the earliest, and, at times, the only evidence of human immunodeficiency virus infection, and may present a diagnostic challenge, particularly in the aviation context. Several aviation medicine specialists have pointed out the safety questions raised by this condition when it presents in otherwise asymptomatic individuals. Since October 1985, U.S. military pilots have been tested for the presence of HIV antibody and grounded if found positive. In May 1991, the Executive Council of the Aerospace Medical Association approved a position statement that supports testing of pilots for infection by HIV, and maintains that "individuals confirmed to be infected should be found medically disqualified for flying duties." While bureaucrats delay in resolving HIV mandatory screening, HIV-encephalopathy may be precipitously brought to light, with symptoms involving ocular motor disorders such as dissociated nystagmus, gaze-evoked nystagmus, and impaired saccadic function and smooth pursuit, frequent signs of HIV cerebellar and pontomesencephalic dysfunction.

AIDS Dementia Complex↗
PubMed1992

Brain-stem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome.

Brain-stem auditory evoked potentials were recorded in 35 human immunodeficiency virus (HIV)-seropositive subjects from the Centers for Disease Control groups III and IV, 24 HIV-negative drug abusers, and 62 normal healthy controls. None of the patients had evidence of neurological complications. History of alcohol consumption was an exclusion criterion. The values of central conduction times I-V and III-V showed significant differences between the HIV-seropositive subjects and normal healthy controls, as well as between the HIV-seropositive subjects and HIV-negative drug abusers. Central conduction times I-III showed no differences between groups, except in the left ear of Centers for Disease Control group IV compared with controls. No statistical differences were found in the central conduction times between HIV-negative drug abusers and normal healthy controls. The results suggest a subclinical involvement of the upper brain stem in HIV infection. It could be produced by direct action of the virus on central nervous system structures.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Electromyographical findings in human chronic Chagas' disease.

An electromyographical investigation of 80 patients with chronic Chagas' disease was made. It was found that 79% of the studied patients had EMG manifestations of old and chronic denervation of the upper and lower limbs without clinical features of nervous system involvement.

Action Potentials↗
PubMed1978

Histological and histochemical changes of the skeletal muscle in human chronic Chagas' disease.

Gastrocnemius muscle biopsies were performed in 7 subjects with chronic Chagas' disease. On clinical and laboratory grounds the selected patients were judged to be healthy, being the only abnormality found the presence of positive serum tests for Chagas' disease. Fibre type grouping of either type I or type II was observed in 5 of the 7 patients. Furthermore, in 2 of the 5 patients showing muscle fibre groupings, angular fibres reacting with NADH and non-specific sterase were also found. These observations strongly suggest denervation associated with reinervation. This picture often can be observed in the skeletal muscle of patients with well compensated denervatory conditions who did not show clinical evidences of denervation.

Adult↗
PubMedDate not supplied

Reading epilepsy.

This is a report of a 21-year-old woman with reading epilepsy. Clinical and electroencephalographic (EEG) observations are presented while the patient read a news magazine in Spanish, read a magazine in English, read an announcement repetitively, viewed comic strips without legends, made a mathematical calculation. Only reading in Spanish produced clinical and EEG paroxysms. This case report supports the "communication" hypothesis as opposed to hypotheses that emphasize proprioceptive and other "lower order" stimuli in evoking seizures while reading.

Adult↗