Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Differential Diagnosis
Disease
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Differentiating signs and symptoms
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Differentiating tests
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CNS lymphoma
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Brain biopsy
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Metastatic brain tumor
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Mycobacterial CNS
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- Prior history of residence in an endemic area.
- Chronic cough, weight loss, hemoptysis
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- PCR of CSF for tuberculosis
- Mycobacterial culture of CSF
- Brain biopsy for acid-fast bacilli staining
- Culture and acid stain positive for acid-fast bacilli
- CXR shows cavitations.
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Aspergillosis
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- Pulmonary lesions in addition to CNS lesions.
- Symptoms may include cough, chest pain, and hemoptysis.
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- CSF fungal culture, galactomannan.
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Cryptococcosis
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- Symptoms include cough, chest pain, and hemoptysis
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- Cryptococcal antigen from CSF and serum
- CSF fungal culture
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Chaga's disease
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- History of residence in Central and South America
- Acute infection is rarely symptomatic,
- Encephalitis or focal brain lesions
- Myocarditis
- Chronic infections in immunocompromised patients develops into encephalitis with necrotic brain lesions causing mass effect.
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- Trypanosoma cruzi in blood, tissue or CSF, PCR of tissue or body fluids, serologic tests.
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CMV infection
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- Most common CNS opportunistic infection in AIDS patients
- Presents with encephalitis, retinitis, progressive myelitis or polyradiculitis.
- In disseminated disease, it involves both liver and renal organs.
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- Brain CT/MRI/biopsy: location of lesions are usually near the brain stem or periventricular areas.
- PCR of CSF with detectable virus is diagnostic.
- Brain biopsy with + staining for CMV or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions.
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HSV infection
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- Seizures, headache, confusion and/or urinary retention can be seen in disseminated disease, which usually affects only immunocompromised or acute infections *In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal.
- Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease.
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- Brain CT/MRI/biopsy: location of lesions is usually the medial temporal lobe or the orbital surface of the frontal lobe.
- PCR of CSF with detectable virus is diagnostic.
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VZ infection
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- Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits, and seizures.
- Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs, and stroke.
- Disseminated varicella zoster virus can occur in adults during primary infection, presenting with pneumonitis and/or hepatitis.
- Disease is a vasculopathy, with hemorrhage and stroke.
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- PCR of CSF with detectable virus is diagnostic.
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Bacterial abscess
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Progressive multifocal leukoencephalopathy
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Cat Scratch Disease
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References
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