HIV brain mass

aka Neurological Mind-boggler 001

Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state. His CT head is shown below.


Q1.Describe the CT Head findings.

Answer and interpretation

This scan shows a left frontoparietal hypodense lesion with surrounding oedema and mass effect which shows enhancement with contrast.

Q2. Outline the differential diagnosis.

Answer and interpretation

In HIV CNS lesions can be divided into those which exhibit mass effect and those that do not.

CNS lesions with mass effect include:

  • toxoplasma encephalitis
  • primary CNS lymphoma
  • tuberculoma (more common in the developing world)
  • other lesions are less common but include brain abscesses secondary to Staphylococcus, Streptococcus, Salmonella, Aspergillus, Nocardia, Listeria & Cryptococcus

NB: toxoplasmosis and primary CNS lymphoma are the most common

CNS lesions without mass effect are commonly due to:

  • progressive multifocal encephalopathy, or
  • HIV-associated encephalitis

Neurological Mind Boggler 700


Neurological Mind-boggler

Intensivist in Wellington, New Zealand. Started out in ED, but now feels physically ill whenever he steps foot on the front line. Clinical researcher, kite-surfer  | @DogICUma |

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