September 2, 2010

Neurological Mind-boggler 001

Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state.
His CT head is shown below.

CT #1

CT #2

Questions

Q1.Describe the CT Head findings.

This scan shows a left frontoparietal hypodense lesion with surrounding oedema and mass effect which shows enhancement with contrast.

Q2. Outline the differential diagnosis.

In HIV CNS lesions can be divided into those which exhibit mass effect and those that do not.

CNS lesions with mass effect include:

  1. toxoplasma encephalitis
  2. primary CNS lymphoma
  3. tuberculoma (more common in the developing world)
  4. other lesions are less common but include brain abscesses secondary to Staphylococcus, Streptococcus, Salmonella, Aspergillus, Nocardia, Listeria & Cryptococcus

NB: toxoplasmosis and primary CNS lymphoma are the most common

CNS lesions without mass effect are commonly due to:

  1. progressive multifocal encephalopathy, or
  2. HIV-associated encephalitis

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  3. Quiz Paediatrics 007
  4. ICU Mind Maps
  5. Pseudobulbar and bulbar palsies

About Paul Young
A proud graduate of The Breakfast Club, Paul is an Intensivist in Wellington, New Zealand. According to his father, Paul studied medicine after performing a cost-effectiveness analysis of his own biomedical fragility – a champion runner as a youth, he now struggles with a zimmer frame. Although he started out in the ED, Paul feels physically ill whenever he steps foot there these days.

Comments

  1. 'In The Fast Lane': Neurological Mind-boggler #001 http://su.pr/2d3EER

  2. Body In Mind says:

    RT @precordialthump: 'In The Fast Lane': Neurological Mind-boggler #001 http://su.pr/2d3EER

  3. Robbo says:

    RT @precordialthump: 'In The Fast Lane': Neurological Mind-boggler #001 http://su.pr/2d3EER – answers available woo hoo!

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