HIV Sequel-MRI

39 yr old known retroviral disease patient  presents  with altered  sensorium and  pyrexia , with CEMRI  suggesting  heterogeneously enhancing vasogenic edema of brainstem  with focal nodular components and unremarkable flow voids  with rest grossly normal, suggesting possibly focal mass lesions of infective etiology  (in view of history) 

Teaching points by Dr MGK Murthy, Dr GA Prasad and Mr Venkat MR technologist

1. Focal intracranial   lesions in Retroviral disease patients are common 

2.Toxoplasmosis (5 to 20% of patients ) (50 to 60% of all  focal lesions) , Primary CNS lymphoma( 3 to 5%)(20% of all focal lesions) ,Progressive multifocal leukoencephalopathy (PML) ( 2 to 4%)  constitute  common aetiologies  with Asia contributing Tuberculosis as important addition

3. MR imaging is not specific to etiology with  10 % of AIDS patients in general showing  focal lesions

4.HIV dementia  is predominant encephalopathy  presentation ( 7 to 25% patients )  with MR suggesting focal ex vacuo findings  fontal regions 

5. Some claim focal intracranial  lesions are on rise on account of HAART (highly active antiretroviral therapy) usually occur with CD4 values less than 200 per microlitres