HIV and an abnormal CT Head

aka 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:

  • toxoplasma encephalitis
  • primary CNS lymphoma
  • tuberculoma (more common in the developing world)
  • 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:

  • progressive multifocal encephalopathy, or
  • HIV-associated encephalitis

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