ring enhancing lesion in hiv positive patient
DESCRIPTION
TRANSCRIPT
A 45-Year-Old Man with a History of Alcohol Abuse and
Rapid Cognitive Decline
Bita Fakhri, MD, MPHBoston University Medical Center
April/01/14
Brain Imaging
DDx of Ring Enhancing Lesions on Brain Imaging
DDx of Ring Enhancing Lesions on Brain Imaging
• Inflammatory (ADEM)• Vascular (Subacute Infarct)• Infectious (bacterial, fungal, mycobacterial,
parasitic)• Neoplastic (primary vs mets)
Inflammatory
• ADEM• MS• PML• Radionecrosis
ADEM Radionecrosis
Vascular
Enhancing Subacute Hemorrhagic Stroke
Neoplastic
metastasis GBM
Infectious• Bacterial (sinusitis, otitis media, dental procedure)
• Fungal (aspergilloma)• Mycobacterial (tuberculoma)• Parasitic (toxo, neurocysticercosis)
Abscess
Approach to HIV Infected Patients with CNS Lesions
• CD4 count• HAART (? Compliance), PPX• Multifactorial• CNS Lesions with or without mass effects
Approach to HIV Infected Patients with CNS Lesions
• CNS lesions with mass effect: TE, PCNSL• CNS lesions without mass effect: PML, HIVE,
CMV encephalitis
Toxoplasma Encephalitis
• Reactivation from prior infection• Fever, headache, AMS, focal neurologic sx, seizure• Supporting lab data: presence of IgG Abs and/or CD4 < 100• Ring enhancement in 90%• If solitary lesion > 4 cm ? PCNSL
Primary CNS Lymphoma• Confusion, lethargy, memory loss, hemiparesis, aphasia, seizures• Constitutional sx in 80%• Irregular, patchy or diffuse enhancement• Equally solitary or multiple
PML
• JC virus• Bilateral, multiple, assymetric areas of demyelination esp. periventricular• Generally not contrast enhancing
HIV Encephalitis
• Subcortical dementia: memory loss, depressive sx, motor abnormalities• Non-enhancing, multiple, “symmetric” lesions (in contrast to PML)
CMV Encephalitis• CD4 < 50• Micronodular or ventriculoencephalitis
Alcoholic Hepatitis
• Hx of heavy alcohol use (>100 g/d) for >= 20 yrs
• Jaundice, anorexia, fever, tender hepatomegaly
• Labs: moderately elevated transaminases (<300) with AST/ALT >= 2
• Clinical and lab features are adequate for establishing dx
Mallory-Denk Bodies in Alcoholic Hepatitis
A 45-Year-Old Man with a History of Alcohol Abuse and
Rapid Cognitive Decline
April/01/14