9. Approach to HIV Infected Patients with
CNS Lesions
โข CD4 count
โข HAART (? Compliance), PPX
โข Multifactorial
โข CNS Lesions with or without mass effects
10. Approach to HIV Infected Patients with
CNS Lesions
โข CNS lesions with mass effect: TE, PCNSL
โข CNS lesions without mass effect: PML, HIVE,
CMV encephalitis
11. Toxoplasma
Encephalitis
โข Reactivation from prior
infection
โข Fever, headache, AMS,
focal neurologic sx, seizure
โข Supporting lab data:
presence of IgG Abs and/or
CD4 < 100
โข Ring enhancement in
90%
โข If solitary lesion > 4 cm ๏
? PCNSL
12. Primary CNS
Lymphoma
โข Confusion, lethargy,
memory loss,
hemiparesis, aphasia,
seizures
โข Constitutional sx in
80%
โข Irregular, patchy or
diffuse enhancement
โข Equally solitary or
multiple
13. PML
โข JC virus
โข Bilateral, multiple, assymetric areas of demyelination esp.
periventricular
โข Generally not contrast enhancing
14. HIV Encephalitis
โข Subcortical dementia: memory loss, depressive sx, motor
abnormalities
โข Non-enhancing, multiple, โsymmetricโ lesions (in contrast to
PML)
16. Alcoholic Hepatitis
โข Hx of heavy alcohol use (>100 g/d) for >= 20
yrs
โข Jaundice, anorexia, fever, tender
hepatomegaly
โข Labs: moderately elevated transaminases
(<300) with AST/ALT >= 2
โข Clinical and lab features are adequate for
establishing dx