Myriad of magnetic resonance imaging findings in human immune deficiency virus positive patients with central nervous system manifestations

Sudhanshu Kathpalia; Namrita Sachdev; Priyanka .; Civilee Nanda

doi:10.18203/2320-6012.ijrms20223260

Authors

Sudhanshu Kathpalia Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India http://orcid.org/0000-0001-7346-4170
Namrita Sachdev Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Priyanka . Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Civilee Nanda Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20223260

Keywords:

CNS manifestations, HIV positive patients, AIDS, HIV related CNS disease

Abstract

Human immuno-deficiency virus (HIV) is a neurotropic virus that affects the central nervous system (CNS) early in the course of illness. Neurological complications are seen in about 60% of the patients and were the major presenting complaints in 20% patients in the pre-highly active anti-retroviral therapy (HAART) era. Imaging especially magnetic resonance imaging (MRI) is thus helpful in shedding light on the causative factor of neurological symptoms in acquired immunodeficiency syndrome (AIDS) patients. It can be used as an adjunct to clinical features and serological/cerebrospinal fluid (CSF) findings to diagnose CNS abnormalities with greater confidence and modify therapeutic strategy accordingly. We conducted a cross-sectional observational study with 12 HIV positive patients for a period of 12 months. MRI evaluation was done using conventional brain sequences. HIV encephalopathy was diagnosed on imaging in 8 patients, polymorphic light eruption (PMLE) in 2 patients, CNS toxoplasmosis in 1 patient and CNS lymphoma in one patient. The clinical details and imaging features of the various manifestations are described. Though there might be a certain degree of overlap in the imaging findings, some imaging findings provide important diagnostic clues for specific diseases, especially on MRI.

Metrics

Metrics Loading ...

References

Ingole NA, Sarkate PP, Paranjpe SM, Shinde SD, Lall SS, Mehta PR. HIV-2 infection: where are we today? J Global Infect Dis. 2013;5(3):110.

National AIDS Control Organization. HIV Surveillance. 2019. Available at: http://naco.gov.in/ surveillance-epidemiology-0. Accessed on 18 November 2022.

L.Celso Hygino da Cruz. Intracranial Infection. In: Scott W. Atlas’ Magnetic Resonance Imaging of the Brain and Spine. 5th edition. Wolters Kluwer. 2017;953-72.

Mindel A, Tenant-Flowers M. Natural history and management of early HIV infection. BMJ. 2001;322(7297):1290-3.

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.

de la Monte SM, Ho DD, Schooley RT, Hirsch MS, Richardson EP Jr. Subacute encephalomyelitis of AIDS and its relation to HTLV-III infection. Neurology. 1987;37(4):562-9.

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

Sakai M, Higashi M, Fujiwara T, Uehira T, Shirasaka T, Nakanishi K, Kashiwagi N, Tanaka H, Terada H, Tomiyama N. MRI imaging features of HIV-related central nervous system diseases: diagnosis by pattern recognition in daily practice. Japanese J Radiol. 2021;39(11):1023-38.

Abidin AZ, Dsouza AM, Nagarajan MB, Wang L, Qiu X, Schifitto G, et al. Alteration of brain network topology in HIV-associated neurocognitive disorder: a novel functional connectivity perspective. Neuroimage Clin. 2017;17:768-77.

Cortese I, Reich DS, Nath A. Progressive multifocal leukoencephalopathy and the spectrum of JC virus-related disease. Nat Rev Neurol. 2021;17(1):37-51.

Berger JR, Aksamit AJ, Clifford DB, Davis L, Koralnik IJ, Sejvar JJ, et al. PML diagnostic criteria: consensus statement from the AAN Neuroinfectious disease section. Neurology. 2013;80:1430-8.

Thurnher MM, Post MJ, Rieger A, Kleibl-Popov C, Loewe C, Schindler E. Initial and follow-up MR imaging findings in AIDS-related progressive multifocal leukoencephalopathy treated with highly active antiretroviral therapy. AJNR Am J Neuroradiol. 2001;22:977-84.

Wright D, Schneider A, Berger JR. Central nervous system opportunistic infections. Neuroimaging Clin N Am. 1997;7(3):513-25.

Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin Infect Dis. 1992;15(2):211-22.

Zufferey J, Sugar A, Rudaz P, Bille J, Glauser MP, Chave JP. Prevalence of latent toxoplasmosis and serological diagnosis of active infection in HIV positive patients. Eur J Clin Microbiol Infect Dis. 1993;12(8):591-5.

Gupta NK, Nolan A, Omuro A, Reid EG, Wang CC, Mannis G, et al. Long-term survival in AIDS-related primary central nervous system lymphoma. Neuro Oncol. 2017;19:99-108.

Annie G. Osborn. In: Osborn’s Brain Imaging, pathology and anatomy. 2nd edition. Elsevier. 2018;417-48.