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1996-02-26
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Document 0442
DOCN M9620442
TI [Cerebral toxoplasmosis. Neuroradiologic diagnosis and prognostic
monitoring]
DT 9602
AU Martin-Duverneuil N; Cordoliani YS; Sola-Martinez MT; Miaux Y; Weill A;
Chiras J; Neuroradiologie Charcot, Hopital de la Salpetriere, Paris.
SO J Neuroradiol. 1995 Sep;22(3):196-203. Unique Identifier : AIDSLINE
MED/96043316
AB Cerebral toxoplasmosis remains the most frequent etiology of cerebral
masses in AIDS. In most cases, the disclosure of multiple enhanced
masses is suggestive of diagnosis of toxoplasmosis and leads to
undertake presumptive therapy. Sometimes, the pattern is less
suggestive, and the possibility of primary cerebral lymphoma (PCL) is a
diagnostic dilemma, because this is a short term life-threatening lesion
in the absence of an undelayed fitting therapy. However, apart from the
periventricular form of PCL, where directly proceeding to biopsy should
be suggested, there is no distinctive pattern of PCL. The most reliable
features in distinguishing between PCL and toxoplasmosis are: solitary
lesion, homogeneous enhancement of a lesion whose diameter is larger
than 2 cm, situation in deep periventricular white matter and limited
edema and mass effect. The presence of haemorrhagic foci in the lesion,
if there is no steroid therapy is rather indicative of toxoplasmosis.
The lack of enhancement on enhanced CT-scan does not allow to eliminate
cerebral toxoplasmosis, and indicate MR examination, or empiric
antitoxoplasmic treatment. The radiologic follow-up depends on clinical
response and on initial pattern. The criteria of response to
antitoxoplasmic treatment are: the decrease in volume or number of
lesions, the decrease of edematous reaction and mass effect (if no
steroid was administered). If the lesion was initially equivocal, the
lack of growth in a 8-day delay is a criterion for toxoplasmosis, just
as the occurring of haemorrhage in the lesions (if there is no
steroid-therapy).
DE AIDS-Related Opportunistic Infections/*DIAGNOSIS/DRUG THERAPY/
RADIOGRAPHY Brain Neoplasms/DIAGNOSIS/RADIOGRAPHY Cerebral
Hemorrhage/DIAGNOSIS/RADIOGRAPHY Cerebral Ventricles/PATHOLOGY
Diagnosis, Differential English Abstract Follow-Up Studies Human
Lymphoma, AIDS-Related/DIAGNOSIS/RADIOGRAPHY *Magnetic Resonance
Imaging Prognosis *Tomography, X-Ray Computed Toxoplasmosis,
Cerebral/*DIAGNOSIS/DRUG THERAPY/RADIOGRAPHY JOURNAL ARTICLE REVIEW
REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).