Stereotactic biopsy of cerebral lesions in acquired immunodeficiency syndrome

The efficacy, mortality and morbidity of CT directed stereotactic biopsy of a cerebral lesion in 32 Human Immunodeficiency Virus (HIV) infected patients between July 1991 and June 1994 who had an atypical presentation for toxoplasmosis or who were failing or intolerant of empirical antitoxoplasmosis treatment was evaluated. An histological diagnosis was able to be made in 85%: progressive multifocal leucoencephalopathy (PML) in 13, primary cerebral lymphoma in 10, toxoplasmosis in 3 and HIV encephalitis in one. Non-specific reactive changes or gliosis were seen in 5 patients. There was no mortality, and morbidity occurred in 2 patients: one intraventricular haemorrhage and one transient third nerve palsy. Correct diagnosis made by image-directed stereotactic biopsy of central nervous system (CNS) disease in acquired immunodeficiency syndrome (AIDS) patients may improve outcome, particularly in those diseases where effective treatment strategies already exist and become increasingly available in the future.