Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients.
Cerebral toxoplasmosis is a frequent complication in immunosuppressed patients such as AIDS (acquired immunodeficiency syndrome). Frequently, lesions are located deep in the brain which are inaccessible for biopsy making rapid diagnosis dependent on accurate interpretation of neuroimaging findings. The commonest cranial CT findings reported in toxoplasmosis are ring enhancing hypodense lesions in basal ganglia or cortical gray matter. Hemorrhage has only rarely been described and is usually seen following antitoxoplasma treatment. We reviewed the records of 11 AIDS patients with cerebral toxoplasmosis and found multiple hemorrhagic cerebral, cerebellar, or brain stem lesions in 7 of 11 patients. Six patients had hemorrhage at the time of initial clinical presentation and one developed hemorrhage following 2 weeks of antitoxoplasma treatment. We conclude that hemorrhagic lesions are frequently found on cranial MRI scans in cerebral toxoplasmosis. AIDS patients presenting with hemorrhagic cerebral lesions should be considered for a trial of presumptive antitoxoplasma treatment.
Bhagavati
Satyakam
S
SUNY Downstate Medical Center, Department of Neurology, New York, New York 11203, USA. Sbhagavati@downstate.edu
Choi
Jan
J
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000818:Animals; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome