0071643192.pdf

INFECTIOUS DISEASE

DIAGNOSIS

■ Serologic testing not helpful (high antibody prevalence)

■ CT: Multiple subcortical lesions

■ Most common in basal ganglia (often multiple)

■ Contrast shows ring enhancement.

TREATMENT

■ Pyrimethamine +sulfadiazine (+folinic acid)

■ Significant edema: Add steroids +phenytoin

CNS LYMPHOMA

■ Polyclonal tumor from EBV

■ Most frequent with CD4 < 100

SYMPTOMS/EXAM

■ Subacute AMS

DIFFERENTIAL

Toxoplasmosis

DIAGNOSIS

CT: Hyperdense/isodense periventricular enhancement

TREATMENT

■ Chemotherapy+radiation

■ Median survival 0.5–2 years

PROGRESSIVEMULTIFOCALLEUKOENCEPHALOPATHY

Jacob-Creutzfeldt (JC) virus reactivation

SYMPTOMS/EXAM

■ Weakness

■ Headache

■ Speech disturbance

■ Cognitive dysfunction

DIAGNOSIS

■ CT: Single or multiple nonenhancing white-matter lesions

■ PCR of the JC virus

TREATMENT

Highly active antiretroviral therapy (HAART)

TUBERCULOSISMENINGITIS

Initiate treatment with isoniazide, rifampin, and pyrazinamide (all of which

enter CSF in presence of meningeal irritation).

HIV is an indication for a head

CT before performing an LP.