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Brain Lesion in HIVAka: Focal Brain Lesion in HIV, HIV-Related Focal Brain Lesion

Indication
1. Approach to suspected focal Brain Lesion in HIV patient
Step 1: Head CT
1. Head CT Positive: Go to Step 2 below
2. Head CT Negative
  1. Obtain more detailed imaging
    1. CT with double-dose contrast or
    2. MRI with gadolinium
  2. Interpretation of secondary imaging
    1. Positive: Go to Step 2 below
    2. Negative: Lumbar Puncture and treat per results
Step 2 Focal Lesion: Check contrast enhancement
1. Positive Contrast Enhancement: Go to Step 3 below
2. Negative for contrast enhancement
  1. Perform MRI with Contrast
  2. Interpret for contrast enhancement
    1. Positive: Go to step 3 below
    2. Negative: Obtain PCR for JC Virus
      1. Pos: Progressive Multifocal Leukoencephalopathy
      2. Neg: Consider LP, other studies
Step 3 Contrast Enhancing: Check for Mass Effect
1. Positive: Neurosurgical consult
  1. Treat intracranial Hypertension
  2. Open biopsy with decompression
2. Negative: Check Toxoplasmosis serology
  1. Positive: Evaluate for effective therapy
  2. Negative: Obtain Epstein-Barr Virus Serology
    1. Positive: Evaluate with biopsy for Lymphoma
    2. Negative
      1. Single CNS lesion: Biopsy
      2. Multiple CNS lesions: Lumbar Puncture
References
1. Weisberg (2001) South Med J 94:272

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This page was written by Scott Moses, MD. This page was last revised on 3/7/2008 9:47:23 AM. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.