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Under the guidance of Dr.M.V.Ramanappa, HOD, Dept of Radiodiagnosis, Santhiram Hospital, Nandyal. Presented by, Dr.P.Sreekanth, 2nd year PG, Dept of Radiodiagnosis, Santhiram Hospital, Nandyal.
HIV ENCEPHALOPATHY
CEREBRAL TOXOPLASMOSIS
Figure 58.10 Typical toxoplasma abscesses and response to treatment. Transverse T2W images (A, C, D) and coronal T1W image (B). Multiple masses of varying sizes with a propensity to involve the basal ganglia and corticomedullary junction and associated with perilesional oedema may occur (A). High signal seen on the T1W images is due to haemorrhage (B). In response to therapy for toxoplasma (C, D), the size of the lesions and the surrounding oedema are reduced. Responding lesions may show increased intensity on T2W images and some show a surrounding low signal rim due to haemosiderin (arrow).
CRYPTOCOCCOSIS
HISTOPLASMOSIS
HISTOPLASMOSIS
Histoplasmosis occurs in up to 5 per cent of AIDS patients in areas where Histoplasma capsulatum is endemic. CNS manifestations include meningitis with involvement of adjacent vessels, and single or multiple abscesses. Imaging may show meningeal enhancement, cerebral infarcts, or focal enhancing lesions with mass effect and oedema.
NEUROSYPHILIS
NEUROSYPHILIS
CNS involvement can occur at any stage of syphilis, in HIVinfection its course may be more aggressive. Meningovascular syphilis causes a small-vessel endarteritis that appears as arterial segmental beading on angiography, with associated infarcts in the basal ganglia. Cerebral gummas are rare, typically arise from the meninges, and appear as mass lesions with variable MR signal characteristics and enhancement.
CEREBROVASCULAR DISEASE
CEREBROVASCULAR DISEASE
Cerebral infarcts occur in fewer than 5 per cent of AIDS patients. Causes include infective vasculitis (CMV, varicella zoster or tuberculosis) and embolism from HIV cardiomyopathy. HIV also causes a dilating vasculopathy that results in fusiform aneurysms of the intracranial vessels.
HERPES VIRUSES
HERPES VIRUSES
Cytomegalovirus, herpes simplex and varicella zoster viruses can cause encephalitis, necrotizing ventriculitis ( Fig. 58.18 ), and myelitis in AIDS. In encephalitis imaging may be normal, show nonspecific white matter lesions or focal enhancing lesions. Ependymal enhancement occurs with ventriculitis; myelitis manifests as nonspecific swelling and signal change in the spinal cord.
HERPES VIRUSES
CANDIDIASIS
CANDIDIASIS
Although mucocutaneous candidiasis is common in HIV-infected patients, CNS involvement is rare. Haematogenous dissemination results in meningitis and/or cerebral abscesses. Imaging appearances are nonspecific; clinical confirmation is dependent on CSF analysis or brain biopsy.
TUBERCULOSIS
TUBERCULOSIS
Intracranial tuberculosis is mostly seen amongst IV drug misusers. The radiological manifestations are similar to those in immunocompetent patients, hydrocephalus and meningeal enhancement being the commonest. Parenchymal lesions, in the form of tuberculomas and abscesses, are more frequent in HIV infection
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