Incidence of brain parenchymal abnormality in a group of HIV positive patients admitted in tertiary care hospital: a prospective descriptive study

Authors

  • S. K. Nath Department of Radiology, Military Hospital Devlali, Nashik, Maharashtra, India
  • S. M. Sudumbrekar Department of Neurosurgery, Command Hospital, Chandigarh, India
  • Sumeet Arora Department of Medicine, Army College of Medical Sciences, New Delhi, India
  • S. K. Rai Department of Orthopaedics, 151 Base Hospital, Guwahati, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20181145

Keywords:

Brain parenchymal lesion, HIV infection, MRI brain

Abstract

Background: Magnetic resonance imaging (MRI) has been used to examine the impact of human immunodeficiency virus (HIV) on the central nervous system (CNS) since the beginning of the disease. The objectives of this study were to determine the incidence of brain parenchymal abnormality in a group of HIV positive patients and to detect and study the profile of MRI patterns of brain lesions in HIV positive patients.

Methods: In our study, total of 28 patients have been evaluated enrolled between 01 December 2013 to 30 December 2014.

Results: During the study period 35 patients on immune-surveillance were screened for brain lesions of which 28 patients met the inclusion criteria and were included in study. The male-female ratio has been found to be 4.6:1 with the mean age of 43 (18-77). Majority of patients presented with headache as main clinical symptom. Out of which 20% normal, 13.3% NSWM, 13.3% atrophy, hematoma 6.6%, infarct 6.6%, toxoplasmosis 13.3%, PML 13.3%, NCC 6.6% and CMV encephalitis 6.6%. Altered mental status and neurological deficit 27.6% and 20.7%, respectively, were two other symptoms following headache. MR imaging detected neuroparenchymal abnormality in 20 (71.4%), out of 28 HIV positive patients. There was no neuroparenchymal abnormality seen in the rest of the 08 patients

Conclusions: MR imaging detected neuroparenchymal abnormality in 20 (71.4%), out of 28 HIV positive patients. Based on our study we can conclude that the MRI of brain is the primary modality to detect the brain lesion in HIV positive patient even if he is asymptomatic clinically.

Metrics

Metrics Loading ...

References

Masamed R, Meleis A, Lee EW, Hathout GM. Cerebral toxoplasmosis: case review and description of a new imaging sign. Clinical Radiol. 2009;64(5):560-3.

Miller RF, Lucas SB, Hall-Craggs MA, Brink NS, Scaravilli F, Chinn RJ, et al. Comparison of magnetic resonance imaging with neuropathological findings in the diagnosis of HIV and CMV associated CNS disease in AIDS. J Neurol Neurosurg Psych. 1997;62(4):346-51.

Letendre SL, Ellis RJ, Everall I, Ances B, Bharti A, McCutchan JA. Neurologic complications of HIV disease and their treatment. Topics in HIV medicine: a publication of the International AIDS Society, USA. 2009;17(2):46.

Thurnher MM, Post MJ. Neuroimaging in the brain in HIV-1 infected patients. Neuroimaging Clin. 2008;18(1):93-117.

Yousry TA, Major EO, Ryschkewitsch C, Fahle G, Fischer S, Hou J, et al. Evaluation of patients treated with natalizumab for progressive multifocal leukoencephalopathy. New England J Med. 2006;354(9):924-33.

McCombe JA, Auer RN, Maingat FG, Houston S, Gill MJ, Power C. Neurologic immune reconstitution inflammatory syndrome in HIV/AIDS Outcome and epidemiology. Neurol. 2009;72(9):835-41.

Crum-Cianflone N, Hullsiek KH, Satter E, Marconi V, Weintrob A, Ganesan A, et al. Cutaneous malignancies among HIV-infected persons. Archives of internal medicine. 2009;169(12):1130-8.

Descamps M, Hyare H, Zerizer I, Ger HJ. Neuroimaging of CNS involvement in HIV. J HIV Ther. 2008;13(3):48-54.

Smith AB, Smirniotopoulos JG, Rushing EJ. Central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiograph. 2008;28(7):2033-58.

Allen LM, Hasso AN, Handwerker J, Farid H. Sequence-specific MR imaging findings that are useful in dating ischemic stroke. Radiograph. 2012;32(5):1285-97.

Donnan GA, Baron JC, Ma H, Davis SM. Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol. 2009;8(3):261-9.

Harris AD, Coutts SB, Frayne R. Diffusion and perfusion MR imaging of acute ischemic stroke. Magnetic Resonance Imaging Clin. 2009;17(2):291-313.

Mark VW, Taub E, Perkins C, Gauthier LV, Uswatte G, Ogorek J. Poststroke cerebral peduncular atrophy correlates with a measure of corticospinal tract injury in the cerebral hemisphere. Am J Neuroradiol. 2008;29(2):354-8.

Sinha S, Sharma BS. Neurocysticercosis: a review of current status and management. J Clin Neurosci. 2009;16(7):867-76.

Martinez JV, Mazziotti JV, Efron ED, Bonardo P, Jordan R, Sevlever G, et al. Immune reconstitution inflammatory syndrome associated with PML in AIDS: a treatable disorder. Neurol. 2006;67(9):1692-4.

Raininko R, Elovaara I, Virta A, Valanne L, Haltia M, Valle SL. Radiological study of the brain at various stages of human immunodeficiency virus infection: early development of brain atrophy. Neuroradiol. 1992;34(3):190-6.

Sclafani DV, Mackay RS, Meyerhoff DJ, Norman D, Weiner MW, Fein G. Brain atrophy in HIV infection is more strongly associated with CDC clinical stage than with cognitive impairment. J Int Neuropsychol Soc. 1997;3(3):276-87.

18. Stubbe-Drger B, Deppe M, Mohammadi S, Keller SS, Kugel H, Gregor N, Evers S, Young P, Ringelstein EB, Arendt G, Knecht S. Early microstructural white matter changes in patients with HIV: a diffusion tensor imaging study. BMC neurology. 2012 Dec;12(1):23.

Zhu T, Zhong J, Hu R, Tivarus M, Ekholm S, Harezlak J, et al. Patterns of white matter injury in HIV infection after partial immune reconstitution: a DTI tract-based spatial statistics study. J Neurovirol. 2013;19(1):10-23.

Engsig FN, Hansen ABE, Omland LH, Kronborg G, Gerstoft J, Laursen AL, et al. Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-Infected patients during the highly active antiretroviral therapy era: a nationwide cohort study. J Infect Dis. 199(1):77-83.

Berger JR, Pall L, Lanska D, Whiteman M. Progressive multifocal leukoencephalopathy in patients with HIV infection. J Neurovirol. 1998;4(1):59-68.

Thurnher MM, Rieger A, Kleibel-Popov C, Settinek U, Henk C, Haberier C. Primary central nervous system lymphoma in AIDS: a wider spectrum of CT and MRI findings. Neuroradiol. 2001;43(1):29-35.

Slone HW, Blake JJ, Shah R, Guttikonda S, Bourekas EC. CT and MRI findings of intracranial lymphoma. Am J Roentgenol. 2005;184(5):1679-85.

Newell ME, Hoy JF, Cooper SG, DeGraaff B, Grulich AE, Bryant M, et al. Human immunodeficiency virus: related primary central nervous system lymphoma. Cancer. 2004;100(12):2627-36.

Ammassari A, Scoppettuolo G, Murri R, Pezzotti P, Cingolani A, Del CB, et al. Changing disease patterns in focal brain lesion-causing disorders in AIDS. Journal Acquired Immune Deficiency Syndromes Human Retrovirol. 1998;18(4):365-71.

Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. New England J Med. 1993;329(14):995-1000.

Simone IL, Federico F, Tortorella C, Andreula CF, Zimatore GB, Giannini P, et al. Localised 1H-MR spectroscopy for metabolic characterisation of diffuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psych. 1998;64(4):516-23.

Chang L, Miller BL, McBride D, Cornford M, Oropilla G, Buchthal S, Chiang F, Aronow H, Beck CK, Ernst T. Brain lesions in patients with AIDS: H-1 MR spectroscopy. Radiology. 1995 Nov;197(2):525-31.

Tipping B, de Villiers L, Wainwright H, Candy S, Bryer A. Stroke in patients with human immunodeficiency virus infection. J Neurol Neurosurg Psych. 2007;78(12):1320-4.

Ortiz G, Koch S, Romano JG, Forteza AM, Rabinstein AA. Mechanisms of ischemic stroke in HIV-infected patients. Neurol. 2007;68(16):1257-61.

Miszkiel KA, Hall-Craggs MA, Miller RF, Kendall BE, Wilkinson ID, Paley MN, et al. The spectrum of MRI findings in CNS cryptococcosis in AIDS. Clinical Radiol. 1996;51(12):842-50.

Tien RD, Chu PK, Hesselink JR, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. Am J Neuroradiol. 1991;12(2):283-9.

Parija SC, Gireesh AR. A serological study of cysticercosis in patients with HIV. Revista do Instituto de Medicina Tropical de São Paulo. 2009;51(4):185-9.

Foyaca-Sibat H, Ibañez-Valdés LD, Awotedu A, Fernandez-Mena C. Neurocysticercosis in the former Transkei. In 7th Internet World Congress for Biomedical Sciences. Inabis. 2002:14-20.

Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg. 1985;62(4):475-95.

Ammassari A, Cingolani A, Pezzotti P, De Luca A, Murri R, Giancola ML, et al. AIDS-related focal brain lesions in the era of highly active antiretroviral therapy. Neurol. 2000;55(8):1194-200.

Downloads

Published

2018-03-23

Issue

Section

Original Research Articles