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MDcooper
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09/29/06 - 08:19 AM

A 35 yr old HIV positive man comes to the medical attention with a 6 month history of progressive memory loss and incontinence.He is taking zidovudine and a protease inhibitor.He first noticed difficulties in hand writing.Neurological exam show deficit in congnitive and fine motor control functions.Lab investigations show a CD 4 count of 25/mm3.MRI show moderate brain atrophy but no focal lesions A lumbar puncture show no CSF abnormalities.Which of the following is the most likely diagnosis.

A.CMV encephalitis

B.cryptococcal meningoencephalitis

C.HIV encephalitis

D.HIV myelopathy

E.primary brain lymphoma

F.PML

G.toxoplasmosis/

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star1
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09/29/06 - 08:23 AM

C.HIV encephalitis

I did not read this topic yet But think its HIV Dementia...

MDcooper
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09/29/06 - 08:24 AM

yes it is the right answer but isnt encephalitis mean CONFUSION and altered mental state.The pt is not complaining of confusion!!

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star1
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09/29/06 - 08:31 AM

in HIV we do have dementia and patient is showing its symptoms and non of other choices are competiable with the HIV encephlitis .

May be some other could get the exact answer

vinidoc
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09/30/06 - 04:22 AM

why cant it be cryptococcal meningitis?

study_ing
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09/30/06 - 06:27 AM

imaging studies wud probably show meningeal enhancement, a nd LP wud reveal abnormalities too

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tolito
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09/30/06 - 09:45 AM

i thought it may be PML cos of his cell count but then, the csf would show changes. hmm. so no changes with hiv enceph?

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study_ing
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10/01/06 - 02:08 AM

in PML we see multiple hypodense NON-ENHANCING LESIONs with no mass effect

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tolito
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10/01/06 - 08:06 AM

thanks study_ing.

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MDcooper
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10/01/06 - 08:52 AM

#10

yes the CT will show the lesions in others and in encephalitis there wont be any lesion??????

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chemamr
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10/01/06 - 11:59 AM

#11

right mdcooper.

the answer would be Hiv dementia that shows diffuse cortical atrophy.

PML: CSF is usually normal or with slight elevation in proteins. But CT would show hypodense lesions without mass effect more commonly in parietoccipital white matter.

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