Answer for BIR CoW 04 Nov 2018
HIV encephalopathy
Findings
Diffuse cortical atrophy with prominent sulcal spaces and mildly enlarged ventricles Confluent bilateral symmetrical hyperintensity noted involving periventricular deep white matter and also involving subcortical white matter. Patchy diffusion restriction noted in genu & splenium corpus callosum. Focal patchy enhancment in right frontal lobe.
Discussion
HIV encephalopathy - progressive subcortical dementia that is a form of subacute encephalitis Etiology and pathology. Cns infection with the hiv virus itself and is not an opportunistic infection. Pathologic findings Atrophy and loss of axons, ill-defined areas of demyelination, gliosis, and infiltration with multinucleated giant cells. The most common finding on NECT scans in patients with HIV encephalopathy is atrophy. Multifocal hypodense areas in the deep white matter are also common. T2-weighted MR scans show ill-defined diffuse or confluent patches of increased signal intensities in the deep white matter. The frontal lobes are the most common sites . White matter lesions in HIV encephalopathy are usually bilateral symmetrical . Gray matter is typically spared, and mass effect is absent. Predominantly sparing of subcortical U fibres which is involved on late stage HIV encephalopathy does not result in enhancement or mass effect. Diffusion tensor imaging depicts Abnormalities in mean diffusivity and fractional anisotropy in the subcortical white matter, Even when the white matter appears normal on conventional T1- and t2-weighted MR images Differential diagnosis Progressive multifocal leukoencephalopathy Bilateral asymmetrical multifocal T2/FLAIR hyperintensity Involving of subcortical U fibres Refference Grainger &Allison's diagnostic Radiology 6th edition Osborn's brain imaging, pathology and anatomy 2nd edition Radiographics
Findings
Diffuse cortical atrophy with prominent sulcal spaces and mildly enlarged ventricles Confluent bilateral symmetrical hyperintensity noted involving periventricular deep white matter and also involving subcortical white matter. Patchy diffusion restriction noted in genu & splenium corpus callosum. Focal patchy enhancment in right frontal lobe.
Discussion
HIV encephalopathy - progressive subcortical dementia that is a form of subacute encephalitis Etiology and pathology. Cns infection with the hiv virus itself and is not an opportunistic infection. Pathologic findings Atrophy and loss of axons, ill-defined areas of demyelination, gliosis, and infiltration with multinucleated giant cells. The most common finding on NECT scans in patients with HIV encephalopathy is atrophy. Multifocal hypodense areas in the deep white matter are also common. T2-weighted MR scans show ill-defined diffuse or confluent patches of increased signal intensities in the deep white matter. The frontal lobes are the most common sites . White matter lesions in HIV encephalopathy are usually bilateral symmetrical . Gray matter is typically spared, and mass effect is absent. Predominantly sparing of subcortical U fibres which is involved on late stage HIV encephalopathy does not result in enhancement or mass effect. Diffusion tensor imaging depicts Abnormalities in mean diffusivity and fractional anisotropy in the subcortical white matter, Even when the white matter appears normal on conventional T1- and t2-weighted MR images Differential diagnosis Progressive multifocal leukoencephalopathy Bilateral asymmetrical multifocal T2/FLAIR hyperintensity Involving of subcortical U fibres Refference Grainger &Allison's diagnostic Radiology 6th edition Osborn's brain imaging, pathology and anatomy 2nd edition Radiographics
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!