Raymond A Smego.
A Diagnostic and Therapeutic Algorithm For HIV-Related Intracranial Mass Lesions in an African Population.
Infect Dis J Jan ;9(2):5-8.
We developed a diagnostic and therapeutic algorithm for patients with HIV/AIDS and central nervous system (CNS) mass lesions that, in most cases, obviates the need for neurosurgical intervention. The approach is based upon available blood tests, chest radiography, routine lumbar puncture studies, SPELT scanning for ring-enhancing lesions seen on computed tomography, and limited therapeutic trials. CNS lymphoma was found in 4 of 26 (15%) study patients, and diagnosis was made solely on the basis of characteristic SPELT scans. Using radiologic and/or clinical response to treatment rather than histopathologic confirmation as our diagnostic standard, the algorithm correctly identified the etiology of focal intracranial lesions in all 23 evaluable patients. A noninvasive algorithmic approach can accurately identify the cause(s) of CNS mass lesions in HIVinfected African patients, and SPELT scanning can replace stereotactic brain biopsy in most cases where opportunistic malignancy is suspected. Costs for SPELT scanning were more than offset by the savings achieved by reduced hospital stays.
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