Skip to main content
SpringerLink
Log in

Focal brain lesions in patients with AIDS: Aetiologies and corresponding radiological patterns in a prospective study

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

We report the results of a hospital-based study of 188 consecutive patients seropositive for the human immune deficiency virus type 1 (HIV-1) who presented in a 4-year period (1988–1991) with possible signs or symptoms of first-ever central nervous system disease. Confirmed diagnoses were cerebral toxoplasmosis in 47 patients (25.0%), HIV-1 encephalopathy in 19 (10.1%), progressive multifocal leucoencephalopathy (PML) in 9 (4.8%), cerebral lymphoma in 1 (0.5%), and other conditions in 9 patients (4.8%). Seventy-three subjects (38.8%) showed focal brain lesions on initial computed tomography or magnetic resonance imaging, which were assessed prospectively. Positive predictivity for toxoplasmosis was 100% if multiple lesions occurred in combination with mass effect or contrast enhancement (23 patients), or if at least one space-occupying or enhancing lesion was located in the basal ganglia or the thalamus (26 patients). Solitary lesions with mass effect or contrast enhancement were seen in 26 patients and were caused by cerebral toxoplasmosis in 22 (84.6%). Eight of the 9 PML patients presented with one or more non-enhancing, non-mass lesions, although the predictive value of this pattern was low (47.1% for PML). Thus, in our epidemiological context, certain imaging findings in HIV-1-seropositive patients were highly predictive of cerebral toxoplasmosis. This may differ from findings from other parts of the world where cerebral toxoplasmosis may be less prevalent among HIV-1-infected individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. AIDS-Zentrum im Bundesgesundheitsamt (1991) AIDS/HIV 1991 — Bericht zur epidemiologischen Situation in der Bundesrepublik Deutschland zum 31.12.1991

  2. Arendt G, Hefter H, Figge C, Neuen-Jacob E, Nelles H-W, Elsing C, Freund H-J (1991) Two cases of cerebral toxoplasmosis in AIDS patients mimicking HIV-related dementia. J Neurol 238:439–442

    PubMed  Google Scholar 

  3. Blum LW, Chambers RA, Schwartzman RJ, Streletz LJ (1985) Progressive multifocal leukoencephalopathy in acquired immune deficiency syndrome. Arch Neurol 42:137–139

    PubMed  Google Scholar 

  4. Centers for Disease Control (1992) HIV/AIDS surveillance report — U.S. cases reported through December 1991

  5. Chrysikopoulos HS, Press GA, Grate MR, Hesselink JR, Wiley CA (1990) Encephalitis caused by human immunodeficiency virus: CT and MR imaging manifestations with clinical and pathological correlation. Radiology 175:185–191

    PubMed  Google Scholar 

  6. Ciricillo SF, Rosenblum ML (1990) Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 73:720–724

    PubMed  Google Scholar 

  7. Dina TS (1991) Primary central nervous system lymphoma versus toxoplasmosis in AIDS. Radiology 179:823–828

    PubMed  Google Scholar 

  8. Elsner C, Dörries K (1991) Persistent polyomavirus infection in kidney tissue of patients with diseases other than progressive multifocal leukoencephalopathy. Virology-Life Sci Adv 10:51–61

    Google Scholar 

  9. Gray F, Gherardi R, Scaravilli F (1988) The neuropathology of the acquired immune deficiency syndrome (ADIS). A review. Brain 111:245–266

    PubMed  Google Scholar 

  10. Handler M, Ho V, Whelan M, Budzilovich G (1983) Intracerebral toxoplasmosis in patients with acquired immune deficiency syndrome. J Neurosurg 59:994–1001

    PubMed  Google Scholar 

  11. Kelly WM, Brant-Zawadzki M (1983) Acquired immunodeficiency syndrome: neuroradiologic findings. Radiology 149:485–491

    PubMed  Google Scholar 

  12. Krupp LB, Lipton RB, Swerdlow ML, Leeds NE, Llena J (1985) Progressive multifocal leukoencephalopathy: clinical and radiographic features. Ann Neurol 17:344–349

    PubMed  Google Scholar 

  13. Kupfer MC, Zee CS, Colletti PM, Boswell WD, Rhodes R (1990) MRI evaluation of AIDS-related encephalopathy: toxoplasmosis vs. lymphoma. Magn Reson Imaging 8:51–57

    PubMed  Google Scholar 

  14. aviopierre AM, Lawler GA (1989) Cerebral toxoplasmosis and lymphoma in patients with acquired immunodeficiency syndrome. Australas Radiol 33:270–275

    PubMed  Google Scholar 

  15. Lee YY, Bruner JM, Van Tassel P, Libshitz HI (1986) Primary central nervous system lymphoma: CT and pathologic correlation. AJR 147:747–752

    PubMed  Google Scholar 

  16. Levy RM, Bredesen DE (1988) Central nervous system dysfunction in acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven Press, New York, pp 29–63

    Google Scholar 

  17. Levy RM, Rosenbloom S, Perrett LV (1986) Neuroradiologic findings in AIDS: a review of 200 cases. AJR 147:977–983

    PubMed  Google Scholar 

  18. Levy RM, Bredesen DE, Rosenblum ML (1985) Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62:475–495

    PubMed  Google Scholar 

  19. Levy RM, Janssen RS, Bush TJ, Rosenblum ML (1988) Neuroepidemiology of acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE (eds) AIDS and the nervous system. Raven Press, New York, pp 13–27

    Google Scholar 

  20. Levy RM, Mills CM, Posin JP, Moore SG, Rosenblum ML, Bredesen DE (1990) The efficacy and clinical impact of brain imaging in neurologically symptomatic AIDS patients: a prospective CT/MRI study. J Acquir Immune Defic Syndr 3:461–471

    PubMed  Google Scholar 

  21. Mark AS, Atlas SW (1989) Progressive multifocal leukoencephalopathy in patients with AIDS: appearance on MR images. Radiology 173:517–520

    PubMed  Google Scholar 

  22. McArthur JC, Cohen BA, Selnes OA, Kumar AJ, Cooper K, McArthur JH, Soucy G, Cornblath DR, Chmiel JS, Wang M-C, Starkey DL, Ginzburg H, Ostrow DG, Johnson RT, Phair JP, Polk BF (1989) Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV-1-infected individuals: results from the multicenter AIDS cohort study. Ann Neurol 26:601–611

    PubMed  Google Scholar 

  23. Navia BA, Petito CK, Gold JWM, Cho E-S, Jordan BD, Price RW (1986) Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 19:224–238

    PubMed  Google Scholar 

  24. Olsen WL, Longo FM, Mills CM, Norman D (1988) White matter disease in AIDS: findings at MR imaging. Radiology 169:445–448

    PubMed  Google Scholar 

  25. Petito CK, Cho E-S, Lemann W, Navia BA, Price RW (1986) Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review. J Neuropathol Exp Neurol 45:635–646

    PubMed  Google Scholar 

  26. Porter SB, Sande MA (1992) Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 327:1643–1648

    PubMed  Google Scholar 

  27. Post MID, Chan JC, Hensley GT, Hoffman TA, Moskowitz LB, Lippmann S (1983) Toxoplasma encephalitis in Haitian adults with acquired immunodeficiency syndrome: a clinicalpathological-CT correlation. AJR 140:861–868

    PubMed  Google Scholar 

  28. Post MID, Sheldon JJ, Hensley GT, Soila K, Tobias JA, Chan JC, Quencer RM, Moskowitz LB (1986) Central nervous system disease in acquired immunodeficiency syndrome: prospective correlation using CT, MR imaging, and pathologic studies. Radiology 158:141–148

    PubMed  Google Scholar 

  29. Post MID, Berger JR, Quencer RM (1991) Asymptomatic and neurologically symptomatic HIV-seropositive individuals: prospective evaluation with cranial MR imaging. Radiology 178:131–139

    PubMed  Google Scholar 

  30. Post MID, Levin BE, Berger JR, Duncan R, Quencer RM, Calabro G (1992) Sequential cranial MR findings of asymptomatic and neurologically symptomatic HIV+ subjects. AJNR 13:359–370

    PubMed  Google Scholar 

  31. Snider WD, Simpson DM, Nielsen S, Gold JWM, Metroka CE, Posner JB (1983) Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 14:403–418

    PubMed  Google Scholar 

  32. So YT, Beckstead JH, Davis RL (1986) Primary central nervous system lymphoma in acquired immune deficiency syndrome: a clinical and pathological study. Ann Neurol 20:566–572

    PubMed  Google Scholar 

  33. Trotot PM, Vazeux R, Yamashita HK, Sandoz-Tronca C, Mikol J, Vedrenne C, Thiébaut JB, Gray F, Cikurel M, Pialoux G, Levillain R (1990) MRI pattern of progressive multifocal leukoencephalopathy (PML) in AIDS. J Neuroradiol 17:233–245

    PubMed  Google Scholar 

  34. Whelan MA, Kricheff II, Handler M, Ho V, Crystal K, Gopinathan G, Laubenstein L (1983) Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations. Radiology 149:477–484

    PubMed  Google Scholar 

  35. Working Group of the American Academy of Neurology AIDS Task Force (1991) Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Neurology 41:778–785

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Heinrich-Heine-University, P.O.Box 101007, D-40001, Düsseldorf, Germany

    Helmuth Steinmetz, Gabriele Arendt & Harald Hefter

  2. Department of Neuropathology, Heinrich-Heine-University, D-40001, Düsseldorf, Germany

    Elisabeth Neuen-Jacob

  3. Institute of Virology and Immunobiology, Julius-Maximilians-University, Versbacher Strasse 7, D-97078, Würzburg, Germany

    Kristina Dörries

  4. Institute of Diagnostic Radiology, Heinrich-Heine-University, D-40001, Düsseldorf, Germany

    Albrecht Aulich & Thomas Kahn

Authors
  1. Helmuth Steinmetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriele Arendt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harald Hefter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabeth Neuen-Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristina Dörries
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Albrecht Aulich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas Kahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steinmetz, H., Arendt, G., Hefter, H. et al. Focal brain lesions in patients with AIDS: Aetiologies and corresponding radiological patterns in a prospective study. J Neurol 242, 69–74 (1995). https://doi.org/10.1007/BF00887818

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00887818

Key words

Search

Navigation