The Efficacy and Clinical Impact of Brain Imaging in Neurologically Symptomatic AIDS Patients

Levy, Robert M.; Mills, Catherine M.; Posin, Jonathan P.; Moore, Sheila; Rosenblum, Mark L.; Bredesen, Dale E.

doi:10.1097/00126334-199003050-00001

Cited by 36 publications

(21 citation statements)

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“…Toxoplasmosis, the most common mass lesion in patients with AIDS, is caused by the ubiquitous parasite, Toxoplasma gondii (44,45). It is an obligate intracellular protozoan that exists in three forms: oocysts, tachyzoites, and bradyzoites.…”

Section: Toxoplasmosismentioning

confidence: 99%

Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation

Smith¹,

Smirniotopoulos²,

Rushing³

2008

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Diseases of the central nervous system (CNS) in patients infected with the human immunodeficiency virus (HIV) result directly from HIV itself or from a variety of opportunistic agents. These infections include progressive multifocal leukoencephalopathy, toxoplasmosis, and cryptococcosis. A resurgence of tuberculosis and neurosyphilis has also been documented. Mass lesions, meningoencephalitis, demyelination, atrophy, and vascular lesions are the commonly encountered imaging findings. The introduction of highly active antiretroviral therapy (HAART) has improved both the clinical and radiologic findings in HIV-infected patients and reduced the number of opportunistic infections. In countries that use HAART, AIDS (acquired immunodeficiency syndrome) dementia complex is becoming the most common neurologic complication of HIV infection, whereas opportunistic infections are still the major cause of neurologic complications in patients from countries that do not commonly use HAART. Immune reconstitution inflammatory syndrome, which occurs in some patients in the weeks to months after the institution of HAART, may alter the typical imaging appearance of infectious diseases involving the CNS. Knowledge of the spectrum of imaging findings of these infectious diseases, as well as the effect that treatment has on imaging appearances, is important in the evaluation of HIV-infected patients.

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Section: Toxoplasmosismentioning

confidence: 99%

Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation

Smith¹,

Smirniotopoulos²,

Rushing³

2008

RadioGraphics

182

104

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“…MRI is more sensitive than CT and has proved useful in the investigation of neurologically symptomatic patients with AIDS. 9 We argued that the detection of early subclinical encephalopathy might be possible with such investigative techniques in asymptomatic patients. If so, such imaging could be used to assess progression of disease and response to treatment, and also to help in elucidating the pathogenetic mechanisms involved in HIV infection.…”

mentioning

confidence: 99%

Serial MRI of the brain in asymptomatic patients infected with HIV: results from the UCMSM/Medical Research Council neurology cohort.

Manji

Connolly²,

McAllister³

et al. 1994

Journal of Neurology, Neurosurgery & Psychiatry

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Seventy-six homosexual or bisexual men underwent two cranial MRI studies at a mean interval of 13 months; 23 were HIV seronegative, 41 seropositive but asymptomatic (Center for Disease Control (CDC) groups II1III), and 12 had AIDS related complex (ARC)IAIDS (CDC group IV). Agreement between two neuroradiologists was rated as very good for assessment of enlargement of ventricles and good for widening of cerebral sulci and the presence of focal lesions. For assessment of serial studies, the agreement was moderate. The prevalence of cerebral atrophy and focal white matter lesions was no higher in the asymptomatic patients (CDC group II/III) than in appropriate seronegative controls. Some patients with ARC/AIDS showed evidence of developing cerebral atrophy during the study period when serial scans were compared. The imaging evidence supports the other data obtained from this cohort, which suggest that no significant CNS involvement occurs in HIV infection before the development of ARC/AIDS.

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“…Levy et al performed a prospective study on 50 neurologically symptomatic AIDS patients. Each patient was evaluated using both modalities; MRI was better than CT for the detection of intracranial pathology and significantly altered the diagnosis and treatment in 40% of these patients 8. Thallium single photon emission CT (SPECT) and positron emission tomography (PET) have been shown as useful adjunctive imaging to further delineate toxoplasmosis or other infection from CNS lymphoma as it has increased thallium uptake on SPECT and greater glucose and methionine metabolism on PET 9…”

Section: Discussionmentioning

confidence: 99%

Seizure as an initial presentation of human immunodeficiency virus: acute toxoplasmosis mimicking glioblastoma multiforme

et al. 2013

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We present a case of a 46-year-old man with a history significant only for hypertension and depression that presented with a new onset seizure resulting from a right parietal lobe mass. Further evaluation determined the parietal mass to be central nervous system toxoplasmosis, which was the initial presentation of his underlying HIV/AIDS. This case provided a diagnostic challenge and demonstrates the importance of a thorough evaluation as it pertains to a newly diagnosed brain lesion.

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The Efficacy and Clinical Impact of Brain Imaging in Neurologically Symptomatic AIDS Patients

Cited by 36 publications

References 0 publications

Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation

Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation

Serial MRI of the brain in asymptomatic patients infected with HIV: results from the UCMSM/Medical Research Council neurology cohort.

Seizure as an initial presentation of human immunodeficiency virus: acute toxoplasmosis mimicking glioblastoma multiforme

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