Resumo
Objetivo: Estudar as lesões anatomopatológicas no SNC, analisando se contribuíram para o óbito
desses pacientes e avaliar a concordância entre os diagnósticos neuropatológicos premortem
e postmortem. Método: Estudo retrospectivo com análise de 90 necrópsias sequenciais de SIDA, realizadas
entre 1989 e 1996, além de busca de dados epidemiológicos/clínicos e comparação com
a suspeita clínica para avaliar concordância entre diagnóstico pre e postmortem. Resultados: Idade média 34 ± 11 anos; 81,1% do sexo masculino; todos apresentavam alguma alteração
no SNC, sendo relevantes para o óbito em 54 (60%) casos. Apenas em 15 (27,8%) desses
54 casos houve suspeita clínica da lesão. As lesões encontradas no SNC foram: toxoplasmose
(34,4%), criptococose (12,2%), citomegalovirose (4,4%), encefalite nodular microglial
(3,3%), meningite bacteriana (2,2%), infecção pelo vírus JC (2,2%), tuberculose/micobacteriose
(2,2%), histoplasmose (1,1%) e paracoccidioidomicose (1,1%). As alterações não relacionadas
ao óbito (40%) foram: gliose, fibrose meníngea focal, infarto antigo, calcificações
e edema. Conclusão: Este estudo confirma que existem diversas alterações no SNC de pacientes com SIDA,
sobretudo infecções oportunistas, frequentemente não suspeitadas clinicamente, evidenciando
a importância da necrópsia. Esses achados sugerem que investigação minuciosa deveria
ser feita no SNC de pacientes com SIDA, particularmente naqueles com diagnóstico tardio
ou que não estão respondendo ao tratamento.
Abstract
Objective: The aim was to study the anatomopathological lesions in CNS, analyzing if they have
contributed to the death of those patients, and to evaluate the agreement between
premortem and postmortem neuropathological diagnoses. Method: Retrospective study on 90 necropsies on patients with AIDS, performed between 1989
and 1996, besides having been performed the search for clinical and epidemiologycals
datas, was done a comparison with the clinical suspicion, to analyze the concordance
between premortem and postmortem diagnoses. Results: The patients’ mean age was 34 ± 11 years, 81.1% were male. CNS lesions were found
in all of the cases. In 54 (60%) cases, CNS lesions of relevance to the death were
found, but there had only been clinical suspicion of such lesions in 15 (27.8%) of
them. The lesions consisted of toxoplasmosis (34.4%), cryptococcosis (12.2%), cytomegalovirosis
(4.4%), microglial nodular encephalitis (3.3%), bacterial meningitis (2.2%), JC virus
infection (2.2%), tuberculosis/mycobacteriosis (2.2%), histoplasmosis (1.1%) and paracoccidioidomycosis
(1.1%). The unrelated lesions with the death (40%) were: gliosis, meningeal fibrosis,
old infarct, calcifications and edema. Conclusion: This study confirms that several changes occurred in the CNS of patients with AIDS,
especially opportunistic infections, that frequently are not suspected clinically.
These findings suggest that detailed investigation should be conducted on CNS of patients
with AIDS, particularly those who are not responding to treatment or with late diagnoses.
Palavras-chave Sistema nervoso central/lesões - síndrome de imunodeficiência adquirida - autopsia
Keywords Central nervous system/injuries - acquired immunodeficiency syndrome - autopsy
