Neurology Book

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Brain Lesion in HIV

Aka: Brain Lesion in HIV, Focal Brain Lesion in HIV, HIV-Related Focal Brain Lesion
  1. Indication
    1. Approach to suspected Focal Brain Lesion in HIV patient
  2. 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
  3. 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
  4. 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
  5. References
    1. Weisberg (2001) South Med J 94:272 [PubMed]

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