Clinical Utility of cranial CT in HIV positive and AIDS patients with neurological disease

An analysis was made of the clinical, pathological and radiological data relating to 117 requests for cranial CT on 83 patients who were HIV positive or had AIDS in one year at St Mary's Hospital. Central to the design was grouping of the patients according to clinical presentation. The aim was to establish whether there was evidence to support the view that, because of their immunocompromised state, these patients may commonly harbour serious, potentially treatable intracranial disease without the usual overt clinical signs. No patient who was only HIV antibody positive had treatable intracranial disease without focal neurological signs. In patients with AIDS, treatable or potentially treatable lesions were mainly confined to those with objective neurological signs or seizures. There is little evidence in this data to support the original hypothesis. While it would be inappropriate to advise that CT should never be carried out in the absence of focal signs or seizures, the results of this study should be useful in ascribing an appropriate degree of urgency to requests for cranial CT in these patients.