Ring Enhancing Lesion in HIV Positive Patient

1,418 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,418
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
15
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Ring Enhancing Lesion in HIV Positive Patient

  1. 1. A 45-Year-Old Man with a History of Alcohol Abuse and Rapid Cognitive Decline Bita Fakhri, MD, MPH Boston University Medical Center April/01/14
  2. 2. Brain Imaging
  3. 3. DDx of Ring Enhancing Lesions on Brain Imaging
  4. 4. DDx of Ring Enhancing Lesions on Brain Imaging • Inflammatory (ADEM) • Vascular (Subacute Infarct) • Infectious (bacterial, fungal, mycobacterial, parasitic) • Neoplastic (primary vs mets)
  5. 5. Inflammatory • ADEM • MS • PML • Radionecrosis ADEM Radionecrosis
  6. 6. Vascular Enhancing Subacute Hemorrhagic Stroke
  7. 7. Neoplastic metastasis GBM
  8. 8. Infectious • Bacterial (sinusitis, otitis media, dental procedure) • Fungal (aspergilloma) • Mycobacterial (tuberculoma) • Parasitic (toxo, neurocysticercosis) Abscess
  9. 9. Approach to HIV Infected Patients with CNS Lesions • CD4 count • HAART (? Compliance), PPX • Multifactorial • CNS Lesions with or without mass effects
  10. 10. Approach to HIV Infected Patients with CNS Lesions • CNS lesions with mass effect: TE, PCNSL • CNS lesions without mass effect: PML, HIVE, CMV encephalitis
  11. 11. 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
  12. 12. Primary CNS Lymphoma • Confusion, lethargy, memory loss, hemiparesis, aphasia, seizures • Constitutional sx in 80% • Irregular, patchy or diffuse enhancement • Equally solitary or multiple
  13. 13. PML • JC virus • Bilateral, multiple, assymetric areas of demyelination esp. periventricular • Generally not contrast enhancing
  14. 14. HIV Encephalitis • Subcortical dementia: memory loss, depressive sx, motor abnormalities • Non-enhancing, multiple, “symmetric” lesions (in contrast to PML)
  15. 15. CMV Encephalitis • CD4 < 50 • Micronodular or ventriculoencephalitis
  16. 16. 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
  17. 17. Mallory-Denk Bodies in Alcoholic Hepatitis
  18. 18. A 45-Year-Old Man with a History of Alcohol Abuse and Rapid Cognitive Decline April/01/14

×