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Inicio Radiología (English Edition) Neurologic emergencies in HIV-negative immunosuppressed patients
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Vol. 59. Issue 1.
Pages 2-16 (January - February 2017)
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Vol. 59. Issue 1.
Pages 2-16 (January - February 2017)
Update in Radiology
DOI: 10.1016/j.rxeng.2016.09.003
Neurologic emergencies in HIV-negative immunosuppressed patients
Urgencias neurológicas en el paciente inmunosuprimido no VIH
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J.A. Guzmán-De-Villoriaa,b,
Corresponding author
jguzman.hgugm@salud.madrid.org

Corresponding author.
, P. Fernández-Garcíaa, P.J. Borrego-Ruiza
a Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b CIBER de Salud Mental (CIBERSAM), Madrid, Spain
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Table 1. Correlation between immunologic deficits and common pathogens.
Table 2. MRI-assisted differential diagnosis of bacterial and fungal abscesses.
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Abstract

HIV-negative immunosuppressed patients comprise a heterogeneous group including transplant patients, patients undergoing treatment with immunosuppressors, uremic patients, alcoholics, undernourished patients, diabetics, patients on dialysis, elderly patients, and those diagnosed with severe or neoplastic processes. Epileptic seizures, focal neurologic signs, and meningoencephalitis are neurologic syndromes that require urgent action. In most of these situations, neuroimaging tests are necessary, but the findings can be different from those observed in immunocompetent patients in function of the inflammatory response. Infectious disease is the first diagnostic suspicion, and the identification of an opportunistic pathogen should be oriented in function of the type and degree of immunosuppression. Other neurologic emergencies include ischemic stroke, cerebral hemorrhage, neoplastic processes, and pharmacological neurotoxicity. This article reviews the role of neuroimaging in HIV-negative immunodepressed patients with a neurologic complication that requires urgent management.

Keywords:
Immunosuppression
Opportunistic infections
Neuroimaging
Organ transplantation
Emergency
Magnetic resonance imaging
Central nervous system
Stroke
Immunosuppressive drugs
Resumen

Los pacientes inmunodeprimidos no VIH (ID-no-VIH) constituyen un grupo heterogéneo que incluye a pacientes trasplantados, en tratamiento inmunosupresor, urémicos, alcohólicos, desnutridos, diabéticos, dializados, de edad avanzada o diagnosticados de un proceso grave o neoplásico. Las crisis epilépticas, el síndrome neurológico focal o la meningoencefalitis son síndromes neurológicos que requieren una actuación urgente. En la mayoría de estas situaciones es necesaria la realización de una prueba de neuroimagen, pero los hallazgos pueden ser diferentes a los observados en el paciente inmunocompetente en función de la respuesta inflamatoria. La enfermedad infecciosa constituye la primera sospecha diagnóstica, y la identificación del patógeno oportunista debe orientarse en función del tipo y grado de inmunosupresión. Otras urgencias neurológicas son: el ictus isquémico, la hemorragia cerebral, los procesos neoplásicos o la neurotoxicidad farmacológica. En este artículo se revisa el papel de la neuroimagen en pacientes ID-no-VIH con una complicación neurológica de manejo urgente.

Palabras clave:
Inmunosupresión
Infecciones oportunistas
Neuroimagen
Trasplante de órganos
Complicación neurológica
Urgencia
Imagen por resonancia magnética
Sistema nervioso central
Ictus
Fármacos inmunosupresores

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