Learning objectives
The aim of this work is to know the radiological manifestations of the entire spectrum of CNS pathology that may appear in the patient affected by HIV.
Background
HIV patients suffer many complications secondary to their viral infection,
and the Central Nervous System (CNS) is the frequent target both of harmful actions caused by HIV itself (such as the dementia-AIDS complex,
which consists of an affectation of the white matter,
which it presents areas of gliosis and demyelination,
as well as tissue destruction that will be responsible for secondary atrophy,
all of which will lead to subcortical dementia),
as infections caused by opportunistic germs that take advantage of the state of immunosuppression,
being...
Findings and procedure details
Neurological involvement is frequent in HIV patients and may be the first manifestation of the disease.
The etiology of these clinical manifestations is very varied:
-Own action of the virus.
-Opportunistic infections.
-Neoplasms.
-Due to the treatment against the virus.
Regarding imaging techniques,
we have CT (with greater availability,
although its negative results are not exclusive for pathology) and MRI (with greater sensitivity and specificity when detecting alterations).
PATHOLOGY
Own action of the virus: HIV encephalopathy or dementia-AIDS complex.
Opportunistic infections:
-Progressive multifocal leukoencephalopathy (PML)...
Conclusion
The pathology of the CNS in HIV patients is very frequent and varied,
and it usually appears in the final stages of the disease.
This pathology can not be diagnosed by clinical data,
and radiological imaging studies are necessary for a correct diagnostic approach and initiate appropriate treatment as early as possible.
On imaging techniques,
the keys are provided by the study of MRI (standard sequences,
DWI,
perfusion and spectroscopy),
always assessed in the clinical and immunological context of the patient.
References
-Alice B.
Smith,
James G.
Smirniotopoulos,
and Elisabeth J.
Rushing.
Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation. RadioGraphics 2008 28: 7,
2033-2058.
-Bowen LN,
Smith B,
Reich D,
Quezado M,
Nath A.HIV-associated opportunistic CNS infections: pathophysiology,
diagnosis and treatment.
Nat Rev Neurol.
2016 Oct 27; 12 (11): 662-674.
doi: 10.1038 / nrneurol.2016.149.
-Robert Y.
Shih and Kelly K.
Koeller.
Bacterial,
Fungal,
and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives: From the Radiologic Pathology Archives.
RadioGraphics...