How does the physician avoid a brain biopsy?
Leading diagnoses in patients with advanced AIDS who have Mass Lesions: o Toxoplasma encephalitis (T. Gondii) 50% of all brain lesions in AIDS patients. o Primary CNS Lymphoma (EBV) 30% of all brain lesions in AIDS patients o (PML, HIV-associated encephalopathy, and CMV encephalitis usually do not cause mass lesions) History o Toxo Headache, confusion, +/- fever; focal weakness, seizures; if advanced, dull affect o Lymphoma All of above and constitutional symptoms (night sweats, weight loss) o PML Rapid neurologic decline (hemiplegia, visual field defects, ataxia, aphasia) o HIV Encephalopathy Progressive memory loss, depression, movement disorders o CMV encephalitis Confusion, focal deficits Laboratory tests o Blood: Anti-toxoplasma IgG antibodies are almost always positive if patient has toxo encephalitis Toxo IgM Abs generally are not detectable in acute infxn; Toxo IgG quantitative levels do not reflect disease activity. Patients with toxo usually have CD4 < 100 Patients with CMV e
