0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
380 Complications of Human Immunodeficiency Virus Type 1irregular. Prominent edema mass effect.) CSF (Normal: 20–30%; Pro-
tein: 10–150 mg/dL; Leukocytes: 0–100 mononuclear cells; Experi-
mental: EBV PCR or in-situ hybridization; cytology positive in <5%).
Suspect with failure to respond to empiric toxoplasmosis treatment.
■Cryptococcal meningitis: CT/MRI (usually normal or increa-
sed intracranial pressure; enhancing basal ganglia in cryptoco-
ccomanon-hypodense areas. Enhancement: neg. Edema mass
effect: ventricular enlargement/obstructive hydrocephalus). CSF
(Normal: 20%; Protein: 30–150 mg/dL; Leukocyte: 0–100 mononu-
clear cells; Glucose: 50–70 mg/dL; India ink positive: 60–80%; cryp-
tococcal antigen nearly 100% sensitive and specific). Cryptococcal
antigen in nearly 100%; in serum, 95%. Definitive diagnosis: CSF
antigen and/or positive cultures.
■CMV: CT/MRI (Location: periventricular, brain stem. Site: conflu-
ent. Enhancement: variable, no prominence). CSF (Protein: 100-1000
mg/dL. Leukocyte: 10-1000 mononuclear cell/uL. Glucose usually
decreased. CMV PCR positive. CSF cultures usually neg. for CMV ).
Definitive diagnosis: brain biopsy with histopathology and/or posi-
tive culture. Hyponatremia (reflects CMV adrenalitis). Retinal exam-
ination for CMV retinitis.
■PML: CT/MRI (location: white matter, subcortical, multifocal. Vari-
able sites. Enhancement: neg. No mass effect). CSF (Normal or
changes associated with HIV infection. Experimental: JC virus PCR).
Definitive diagnosis: stereotactic biopsy, antibody stain to SV40 ( JC
virus). Characteristic inclusions in oligodendrocytes; bizarre astro-
cytes.
■HIV-associated dementia: CT/MRI (Location: diffuse, deep, white
matter hyperintensities. Site: diffuse, ill-defined. Enhancement: neg-
ative. Atrophy: prominent. No mass effect.) CSF (Normal: 30–50%.
Protein: increased in 60%. Leukocyte: increased in 5–10% (mononu-
clear cells) beta2-microglobin elevated (>3 mg/L)). Neuropsycholog-
ical tests show subcortical dementia and typical scan. Mini-mental
examination is insensitive; use timed tests.
■Neurosyphilis: CT/MRI (Aseptic meningitis: may show meningeal
enhancement). CSF (Protein: 45–200 mg/dL. Leukocyte: 5–100
mononuclear cells. VDRL positive: sensitivity, 65%; specificity, 100%
positive. Experimental: PCR). Serum VDRL and FTA-ABS are lue
in >90%; false negative serum VDRL in 5–10% with tabes dor-
salis or general paresis. Definitive: positive CSF VDRL (found in
60–70%).