Wernicke's encephalopathy: occurrence and pathological aspects in a series of 400 AIDS patients.

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Wernicke's encephalopathy: occurrence and pathological aspects in a series of 400 AIDS patients.

Acta Biomed Ateneo Parmense. 1992;63(1-2):43-9. Unique Identifier : AIDSLINE MED/94055527
Boldorini R; Vago L; Lechi A; Tedeschi F; Trabattoni GR; V Cattedra di Anatomia patologica dell'Universita di Milano.

Abstract: BACKGROUND. Wernicke encephalopathy (WE), acute (microhaemorrhages) and chronic (proliferation of capillaries) is actually considered as a not uncommon, and curable, condition in several diseases, and not only in alcoholic patients. Why serotoninergic nuclei, and whether blood brain barrier (BB) are involved were our questions. METHODS. In a dramatic series of AIDS cases we selected 380 brains, all belonging to drug addicted subjects. In all Thiamine administration had been under 20 mg pro die and by oral way. In the cases considered, opportunistic infections were present in the 40%, and/or HIV specificity in the 35%. RESULTS. Acute WE was found in nearly the 10%. All patients presented with CNS lesions, other than those of WE, but HIV specificity was found only in 5. They all showed changes in Choroid Plexus, namely alterations of various type of the cuboid epithelium, such as swelling, disruption, hyperplasia. DISCUSSION. WE is set in connection with pyruvate accumulation at capillary level, likely bound to the Thiamine deficiency and to the lack of energy thus induced. Apart from obvious haemorrhagic aspects, CFS studies in WE are lacking. Choroid structure is not merely a permeable membrane (CSF is not a filtrate). Our findings would suggest that Thiamine plays a role in the energy supply to BB. Moreover, the existence of free nerve endings through the ependyma for the release and uptake of monoamines, allows to consider the elective involvement of serotoninergic neurons as somehow connected to the choroid plexus changes described.

Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/*PHYSIOPATHOLOGY Alcohol Amnestic Disorder/COMPLICATIONS/ETIOLOGY/PHYSIOPATHOLOGY Blood-Brain Barrier Brain/*PHYSIOPATHOLOGY Choroid Plexus/METABOLISM/PHYSIOPATHOLOGY Female Human Male Substance Abuse, Intravenous/COMPLICATIONS Thiamine Deficiency/PHYSIOPATHOLOGY Wernicke's Encephalopathy/COMPLICATIONS/ETIOLOGY/*PHYSIOPATHOLOGY JOURNAL ARTICLE
940228
M9420797

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