Cranial CT in acquired immunodeficiency syndrome: spectrum of diseases and optimal contrast enhancement technique

Post, M. Judith Donovan; Kursunoglu, Sevil; Hensley, George T.; Chan, Jason C. K.; Moskowitz, Lee B.; Hoffman, Thomas A.

doi:10.2214/ajr.145.5.929

Cited by 71 publications

(19 citation statements)

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“…24,25 Another explanation for the common finding of toxoplasma encephalitis in our study may be the improvement in neuroradiological diagnosis techniques in comparison to former studies without MRI in some of their patients. 20 The neuroradiological findings of cerebral toxoplasmosis on computer tomographic images (CT) typically consists of multiple areas of iso-or hypodensity with ring or nodular enhancement on postcontrast CT. 26,27 On T2-weighted images, lesions are usually hyperintense. On T1-weighted images lesions show iso-or hypointensity.…”

Section: Discussionmentioning

confidence: 99%

“…20,29 Most neuroradiological toxoplasma studies have been carried out in patients with AIDS. [26][27][28] In view of the fact that in that situation toxoplasma encephalitis seemed rare in patients after BMT little was known about the typical MRI appearance in these patients. One important difference from patients with AIDS is the usually significant reduction in white cells, red cells and platelets after BMT.…”

Section: Discussionmentioning

confidence: 99%

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Opportunistic CNS infection after bone marrow transplantation

Maschke

Dietrich

Prumbaum³

et al. 1999

Bone Marrow Transplant

132

100

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Summary:We retrospectively identified opportunistic CNS infections in 655 patients who had undergone allogeneic, syngeneic or autologous BMT or PBSCT between 1990 and 1997. Twenty-seven patients (4%) developed CNS infections. All CNS infections occurred in allogeneic BMT or PBSCT patients. The most common CNS infections were toxoplasma encephalitis (74%) and cerebral aspergillosis (18%). Furthermore, we identified one patient with candida encephalitis and one patient with viral encephalitis. Overall mortality of patients with opportunistic CNS infection was 67%. There were two different groups of toxoplasma encephalitis with a different appearance on MR imaging. The first group showed edema, but no gadolinium enhancement, whereas the second group exhibited typical MRI appearances with the exception of frequent hemorrhagic transformation. The first group had a significant shorter latency between BMT and onset of CNS infection (mean 45 days vs 180 days, P = 0.02), a significant higher daily dose of corticosteroids as treatment for graft-versus-host disease (GVHD) (P = 0.01), more severe GVHD and a higher mortality (71% vs 36%). This study shows that the most common CNS infections in our patient population are toxoplasma encephalitis and cerebral aspergillosis, that there are two distinct subgroups of toxoplasma encephalitis and that CNS infections occur after allogeneic BMT only. Keywords: CNS infection; cerebral toxoplasmosis; cerebral aspergillosis Both allogeneic and autologous BMT are associated with several neurologic complications secondary to the underlying disease and prolonged myelosuppression. [1][2][3][4] The use of immunosuppressive drugs such as corticosteroids and cyclosporine in order to avoid rejection of the allograft and to control graft-versus-host disease (GVHD) is another major risk factor for neurologic complications especially CNS infections. In previous studies the most common complications were cerebral hemorrhage, metabolic encephalopathy and CNS infection. 1-5 Neurologic complications were more frequent in patients when AML was the underlying disease than in other leukemia patients. 4

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opportunistic CNS infection after bone marrow transplantation

Maschke

Dietrich

Prumbaum³

et al. 1999

Bone Marrow Transplant

132

100

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“…The single most useful tool in investigating a sus pect case of PML is magnetic resonance imaging (MRI) which is superior to computed tomography (CT) especial ly in detecting early lesions [153,154], Lesions have a pro pensity for the grav-white matter junction but in up to 20% of cases gray matter involvement has been docu mented by MRI. These lesions are usually not contrast enhancing and space-occupying.…”

Section: Ia Gn Osismentioning

confidence: 99%

Progressive Multifocal Leukoencephalopathy: Molecular Biology, Pathogenesis and Clinical Impact

1997

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The human polyomaviruses JC virus (JCV) and BK virus (BKV) have long been known as onco- and neurooncogenic. Interest in their oncogenic potential has reemerged with the discovery of simian virus 40 DNA in human brain tumors including the pituitary as well as in bone tumors and mesotheliomas. The only human disease caused by an infection with the human polyomavirus JCV is progressive multifocal leukoencephalopathy (PML) characterized by a lytic infection of oligodendrocytes with consecutive demyelination. Malignant transformation of cell lines appears to be caused by a complex interaction of the viral large T (tumor) antigen with several transcription factors and tumor suppressor proteins such as p53 and the retinoblastoma protein. PML, once an extremely rare disease, has become much more frequent in the western world owing to the AIDS pandemic. An exceedingly complicated, cell-, tissue- and species-specific pattern of protein-DNA interaction and negative as well as positive feedback regulation by at least a dozen proteins and possibly mutations in the JC viral promoter-enhancer region govern host range and development of PML. The intricate molecular and immunological prerequisites ultimately leading to PML in humans have not yet been completely elucidated.

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“…The diagnosis of neurotoxoplasmosis was considered to be confirmed by resolution of typical neurological signs and symptoms and cerebral lesions under antitoxoplasmic treatment (5). For the purpose of this study, only patients with focal cerebral lesions demonstrated by cranial computer tomography (CT) (6) and with antitoxoplasmic IgG serum antibodies were considered eligible for evaluation. None of the patients had a history of previous neurotoxoplasmosis or was on a prophylactic antiparasitic regimen at the time this infection developed.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of pyrimethamine/sulfadoxine in the prevention of toxoplasmic encephalitis relapses andPneumocystis carinii pneumonia in HIV-infected patients

Ruf

Schürmann

Bergmann

et al. 1993

Eur. J. Clin. Microbiol. Infect. Dis.

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The efficacy and safety of 25 mg pyrimethamine plus 500 mg sulfadoxine given twice a week in preventing relapses of AIDS-related toxoplasmic encephalitis was evaluated in an open study. The 56 HIV-infected patients evaluated had responded to intensive treatment with pyrimethamine/clindamycin prior to starting the present prophylactic regimen. Four patients (7 %) experienced relapse while on pyrimethamine/sulfadoxine. The probability of freedom from relapse was > 90% for 12 months and > 80% for 24 months. Side effects comprised mild or moderate allergic reactions which occurred in 23 patients (41 %), leading to discontinuation in four patients (7%). Forty-nine of the 56 patients did not have a history of Pneumocystis carinii pneumonia and did not receive antiparasitic prophylaxis other than pyrimethamine/sulfadoxine; two of them (4 %) developed pneumocystosis. The probability of freedom from pneumocystosis was about 90 % for 24 months. Pyrimethamine/sulfadoxine twice a week appears to be a promising regimen for prevention of toxoplasmic encephalitis, and also appears to provide protection against Pneumocystis carinii pneumonia. Although allergic reactions are usually mild and disappear on continuation, they may limit the value of this regimen.

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Cranial CT in acquired immunodeficiency syndrome: spectrum of diseases and optimal contrast enhancement technique

Cited by 71 publications

References 0 publications

Opportunistic CNS infection after bone marrow transplantation

Opportunistic CNS infection after bone marrow transplantation

Progressive Multifocal Leukoencephalopathy: Molecular Biology, Pathogenesis and Clinical Impact

Efficacy of pyrimethamine/sulfadoxine in the prevention of toxoplasmic encephalitis relapses andPneumocystis carinii pneumonia in HIV-infected patients

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