Beruflich Dokumente
Kultur Dokumente
Aprilia
Moderator : dr. Yovita Andhitara, Sp.S,
Msi.Med, FINS
Lumbar puncture
INDICATION
Williams J, Lye D and Umapathi T. Diagnostic lumbar puncture: minimising complications Internal Medicine Journal 2008;38: 587-9
Lumbar puncture
Contraindications
Absolute contraindications for lumbar puncture are
The presence of infected skin over the needle entry site
The presence of unequal pressures between the supratentorial and
infratentorial compartments.
Williams J, Lye D and Umapathi T. Diagnostic lumbar puncture: minimising complications Internal Medicine Journal 2008;38: 587-9
Lumbar puncture
Indications for performing brain CT scanning before lumbar puncture in
patients with suspected meningitis include the following [8] :
Patients who are older than 60 years
Patients who are immunocompromised
Patients with known CNS lesions
Patients who have had a seizure within 1 week of presentation
Patients with an abnormal level of consciousness
Patients with focal findings on neurologic examination
Patients with papilledema seen on physical examination, with clinical
suspicion of an elevated ICP
Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and
Adolescents
(Last updated December 10, 2015; last reviewed December 10, 2015)
Table 2. Treatment of AIDS-Associated Opportunistic
Infections
(Includes Recommendations for Acute Treatment and Secondary Prophylaxis/Chronic
Suppressive/Maintenance Therapy)
Cerebral Toxoplasmosis
imaging
CT
Typically, cerebral toxoplasmosis appears as multiple hypodense regions
predominantly in the basal ganglia and at the corticomedullary junction.
However, they may be seen in the posterior fossa. Size is variable, from less
than 1 cm to more than 3 cm, and there may be associated mass effect.
enhancement: following administration of contrast there is nodular or ring
enhancement which is typically thin and smooth 5
double-dose delayed scan: may show a central filling on delayed scans
calcification: seen in treated cases; may be dot-like or thick and 'chunky'
MRI
T1: may be difficult to identify, but are typically isointense or hypointense
T2
intensity is variable, from hyperintense to isointense
hyperintense: thought to represent necrotising encephalitis
isointense: thought to represent organising abscess 4
lesions are surrounded by perilesional oedema
Kornienko VN, Pronin IN. Diagnostic Neuroradiology. Springer Verlag. (2009) ISBN:3540756523
y RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin. N. Am. 1997;7 (2): 1
Fig. (a) Non-contrast CT scan showing an extensive hypodense lesion
in the area of the right basal ganglia with mass effect. (b) Contrast
enhancement shows multiple ring enhancing lesions within the
hypodense mass. This was a case of cerebral toxoplasmosis as the
patient recovered completely with drug treatment for this condition