HYDROCEPHALIE: UN CAS RARE DE TOXOPLAMOSE CEREBRALE DANS LE CADRE D\'UN SYNDROME D\'IMMUNO-DEFICIENCE ACQUISE

Abstract

HYDROCEPHALUS: A RARE PRESENTATION OF CENTRAL NERVOUS SYSTEM TOXOPLASMOSIS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME SUMMARY The incidence of HIV infection and the neurological complications are increasing, especially in developing countries. Hydrocephalus due to cerebral toxoplasmosis is very rare and only 7 cases have been reported in the literature . The authors report a case of hydrocephalus related to toxoplasmosis of the 4th ventricles in a HIV patient successfully treated medically without shunting. The mechanism of the hydrocephalus is a necrotizing ependymitis and plexitis obstructing the CSF flow although the cerebral parenchyma has a normal CT appearance in many cases. CNS toxoplasmosis should be ruled out in any immuno-deficient patient with hydrocephalus of unknown origin. The permanent CSF shunting may not be necessary in hydrocephalus due to CNS toxoplasmosis, and external CSF shunting may only rarely be needed. RESUME Les auteurs presentent un cas d\'hydrocephalie associee a une toxoplasmose du IV eme ventricule chez un patient HIV positif, traite medicalement avec succes, sans derivation du LCS. Le mecanisme de l\'hydrocephalie est une ependymite et une plexite necrosante obstruant la circulation du LCS, meme si le parenchyme cerebral apparait normal au scanner dans plusieurs cas. Une toxoplasmose du systeme nerveux central doit etre recherchee chez tout patient immunodeprime avec une hydrocephalie d\'etiologie indeterminee. Une derivation permanente du LCS ne serait pas necessaire au cours de l\'hydrocephalie entrant dans ce cadre. La derivation ventriculaire externe peut etre implantee dans de rares conditions. Key Words: CNS toxoplasmosis, AIDS, hydrocephalus, medical treatment, Cameroon, Afrique, Cameroun, Hydrocephalie, Toxoplasmose, VIH, SIDA African Journal of Neurological Sciences Vol.23(2) 2004