title: Substantia nigra hyperechogenicity and CSF dopamine depletion in HIV.
abstract: Dopaminergic dysfunction is thought to play a pivotal role in human immunodeficiency virus (HIV)-related dementia. Decreased dopamine (DA) levels in the cerebrospinal fluid (CSF) and neuronal loss in the substantia nigra (SN) have been reported in HIV-infected patients, suggesting nigrostriatal damage. Structural changes detectable as hyperechogenicity in transcranial ultrasound (TCS) scans of the SN have been reported in patients with Parkinson's disease (PD) and other neurological conditions. In this study, we assessed the echomorphology of the SN in 40 HIV-positive patients compared to 40 age- and sex-matched healthy controls and correlated these findings with CSF levels of DA and the metabolites homovanillic acid (HVA) and 3,4-dihydroxy phenylacetic acid (DOPAC) and with neuropsychologic performance. We observed that the SN of HIV-infected patients was hyperechogenic relative to that of controls (0.07 +/- 0.05 vs. 0.04 +/- 0.07 cm(2); mean +/- SEM; P < 0.001) and that this SN hyperechogenicity was correlated with decreased DA levels in the CSF, decreased CD4 cell count, and an impaired performance in the psychopathology assessment scale (AMDP) subtest for drive and psychomobility. An association to CDC stage, duration of HIV infection, or presence of HIV dementia was not observed. Our results indicate changes in the nigrostriatal system in HIV-infected patients that are detectable as hyperechogenic SN precede prominent extrapyramidal symptoms and cognitive dysfunction.
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. mark.obermann@uni-due.de
authors.forename: Mark
authors.initials: M
authors.lastname: Obermann
authors.forename: M
authors.initials: M
authors.lastname: Küper
authors.forename: O
authors.initials: O
authors.lastname: Kastrup
authors.forename: O
authors.initials: O
authors.lastname: Yaldizli
authors.forename: S
authors.initials: S
authors.lastname: Esser
authors.forename: J
authors.initials: J
authors.lastname: Thiermann
authors.forename: E
authors.initials: E
authors.lastname: Koutsilieri
authors.forename: G
authors.initials: G
authors.lastname: Arendt
authors.forename: H-C
authors.initials: HC
authors.lastname: Diener
authors.forename: M
authors.initials: M
authors.lastname: Maschke
mesh_terms: D015102:3,4-Dihydroxyphenylacetic Acid / Q000134:cerebrospinal fluid; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D002851:Chromatography, High Pressure Liquid; D004298:Dopamine / Q000134:cerebrospinal fluid* / Q000172:deficiency*; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging* / Q000276:immunology; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013129:Spinal Puncture; D013378:Substantia Nigra / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D015102:3,4-Dihydroxyphenylacetic Acid; D004298:Dopamine; D006719:Homovanillic Acid