Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
NEURORADIOLOGY OF ACQUIRED IMMUNODEFICIENCY SYNDROME
AIDS and the Nervous System. Rosenblum ML et al, eds. New York, Raven Press, p. 121-53, 1988.. Unique Identifier : AIDSLINE ICDB/89648466 De La Paz R; Enzmann D; Dept. of Neuroradiology, Room S070, Stanford Univ. Medical Sch.,; Stanford, CA 94305
Abstract:
Magnetic resonance imaging (MRI) and computerized tomography (CT) scanning are essential in the evaluation of AIDS patients (pts) with neurological symptoms. MRI is the more sensitive of the two techniques, but has poor tissue specificity. A specific etiological diagnosis may not be possible with either technique. Confirmation by biopsy or the response to treatment is often needed. The application of CT and MRI in the evaluation of neurologically symptomatic pts with AIDS is discussed including the pathology of toxoplasmosis, candidiasis, cryptococcal infection, coccidioidomycosis, viral infection, progressive multifocal leukoencephalopathy, and neoplasms. The finding of multiple focal cerebral lesions on MRI and CT scans usually indicates Toxoplasma gondii infection. Toxoplasmosis may, however, coexist with primary CNS lymphoma or with fungal, mycobacterial, or viral infection. The presence of a solitary focal cerebral lesion, especially on MRI scans, suggests lymphoma or infection with an agent other than T gondii. Focal cerebral lesions show a variety of complex signal patterns on MRI and enhancement patterns on CT, none of which are specific for a single etiology. Focal lesions on MRI and CT scans usually are associated with focal neurological deficits, but a significant minority of these lesions may cause only generalized complaints. MRI and CT are both useful for monitoring therapy and show a reduction in the size, number, and enhancement of lesions with successful treatment. Diffuse abnormality of the white matter, seen best on MRI, and cerebral atrophy, are common findings in AIDS pts. Diffuse white-matter lesions are seen as areas of high signal intensity on T2-weighted MRI scans and as areas of low attenuation on CT scans. These findings are usually associated with nonfocal symptoms, but focal deficits caused by meningeal, peripheral nerve, or spinal cord involvement also may be seen. Atrophy is the most common finding on the CT scans of children with AIDS. Bilateral basal ganglia and deep white-matter calcification are also seen in children, but have not been observed in adults with AIDS. Because MRI is more sensitive than CT in detecting potentially treatable focal cerebral lesions, it should be the first neurodiagnostic study done in AIDS pts with suspected brain involvement, even when focal neurological deficits are absent. (21 Refs)
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/*RADIOGRAPHY Atrophy Brain/PATHOLOGY/RADIOGRAPHY Brain Diseases/ETIOLOGY/*RADIOGRAPHY Brain Neoplasms/PATHOLOGY/RADIOGRAPHY Comparative Study Human Leukoencephalopathy, Progressive Multifocal/PATHOLOGY/RADIOGRAPHY Magnetic Resonance Imaging Opportunistic Infections/PATHOLOGY Tomography, X-Ray Computed MONOGRAPH REVIEW, TUTORIAL REVIEW
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
