Presentations: altered mental status with headache and fever.He had been receiving antiretroviral medications until approximately 5 years ago, when he dropped out of care.
The patient has taken no medications since that time and has no history of AIDS-related problems. My dear desperado movie download drama coolFamily members report that he has had some memory loss and unusual behavior for the past 2 weeks. On physical examination, he is confused and disoriented but does not appear to be chronically ill. An MRI scan of the head shows a single ring-enhancing lesion within the left cerebral hemisphere arising from the basal ganglia with significant mass effect, including midline shift. The patient is hospitalized, and high-dose dexamethasone is begun. Toxoplasma 1gM titer is negative, andToxoplasma lgG titer is positive. Cytomegalovirus 1gM titer is negative, and cytomegalovirus lgG titer is positive. Which of the following is most appropriate for initial management of this patient A. Perform lumbar puncture for cerebrospinal fluid culture and cytologic studies D. Tacx training softwareIn Toxoplasmosis- multiple ring enhancing lesions will appear on MRI. In CMV encephalitis- I am not sure, but I never read about any ring enhancing lesions. However, he does have other features that are more typical of toxoplasmosis: 1) the lesion arises from the basal ganglia, and 2) serologic studies indicate past infection consistent with reactivation of quiescent infection that occurs with AIDS-related immunodeficiency. Ring Enhancing Lesions Usmle Plus Either SulfadiazineThe most appropriate management is to treat this patient presumptively for toxoplasmosis with pyrimethamine plus either sulfadiazine or clindamycin and to monitor his clinical and radiographic treatment response. Biopsy of the lesion is indicated only if he does not respond to initial treatment. Primary central nervous system lymphoma is a possible diagnosis for which lumbar puncture can be done to detect Epstein-Barr virus DNA. This test is reported to be both sensitive and specific for lymphoma in this setting. However, lumbar puncture is contraindicated in this patient because of the significant mass effect seen on the MRI scan. Cytomegalovirus encephalitis would not present as a mass lesion, and a bacterial brain abscess is no more common in AIDS patients than in other hosts. If his CD4 cell count were considerably higher than 200L, a bacterial abscess would be more likely. Or organisms spread via bloodstream from endocarditis, or pneumonia. If HIV then 90 its:toxoplasmosis or lymphoma Presentation: headache is most common symptom with focal neurological deficits. Dig: CT scan with contrast or MRI If considering bacterial abscess do biopsy of lesion with Gram stain and cluture Tx: Depends on etiology -HIV pt: Primethamine and sulfadiazine -Streptococcus: penicillin -Gram bacilli: ceftazidime -anaerobe: metronidazole. Most caused by virus although any bacteria or protozoa can cause it.
0 Comments
Leave a Reply. |
AuthorLuis ArchivesCategories |