9. Approach to HIV Infected Patients with
CNS Lesions
• CD4 count
• HAART (? Compliance), PPX
• Multifactorial
• CNS Lesions with or without mass effects
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. 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. Primary CNS
Lymphoma
• Confusion, lethargy,
memory loss,
hemiparesis, aphasia,
seizures
• Constitutional sx in
80%
• Irregular, patchy or
diffuse enhancement
• Equally solitary or
multiple
13. PML
• JC virus
• Bilateral, multiple, assymetric areas of demyelination esp.
periventricular
• Generally not contrast enhancing
14. HIV Encephalitis
• Subcortical dementia: memory loss, depressive sx, motor
abnormalities
• Non-enhancing, multiple, “symmetric” lesions (in contrast to
PML)
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
