CT brain demonstration of basal ganglion calcification in adult HIV/AIDS patients
Involvement of the basal ganglia in AIDS encephalopathy is well documented
in both adults and children. The pathology remains obscure. A type of inflammation with increased vascularity and disruption of the blood-brain barrier has been postulated. Calcification of the basal ganglia in encephalopathic HIV/AIDS children has been relatively well documented. Only two adult HIV cases with basal ganglion calcification (BGC) have been reported in the literature. At our institution over the past few years, we have noted an increasing number of adult AIDS patients with neurological complications, demonstrating BGC on CT examination. A retrospective review was done. Ninety-six adult cases were identified with BGC. Of these, 38 patients were HIV positive. Review of the 38 HIV-positive cases revealed that all of the patients presented clinically with encephalopathic symptoms, and all showed BGC associated with varying degrees of atrophy on CT scan. Reports of
paediatric HIV cases with BGC and encephalopathy have suggested that the BGC is the end-stage phenomenon of a type of vasculopathy associated with blood-brain barrier disruption. The calcifications were seen to be progressive, as was the encephalopathy. The presence of BGC was deemed to be a poor prognostic indicator. Our study shows that BGC
is not uncommon in AIDS encephalopathic adults. Further, since the radiological findings and clinical presentations in adults are the same as in children, we suggest that the pathological processes are also the same and that, in adults, as in children, BGC is the end-stage manifestation of an HIV vasculopathy.
South African Journal of Radiology Vol. 11 (4) 2007: pp. 76-78