Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations

CT examination of the central nervous system was performed in 19 patients with acquired immunodeficiency syndrome (AIDS). Eighteen patients were homosexuals, and five drug abusers. Parenchymal and meningeal inflammations were seen in patients with intracranial manifestations of the disease. The most common demonstrable lesion in the parenchyma was toxoplasmosis, which produced ring enhancement, solid enhancement, and nonenhancing focal edema. The most common meningeal inflammation was cryptococcosis, which was diagnosed by examination of the cerebrospinal fluid and did not show specific CT changes. It is concluded that toxoplasmosis and cryptococcosis should be the first diagnostic consideration in patients with neurologic findings who have a history of homosexuality and/or intravenous drug abuse and previous unusual infections or anergy. A delayed contrast scan, single or double dose, appears to be the most accurate method of outlining the total extent of disease thereby helping to locate the best biopsy site for pretreatment diagnosis. Empirical institution of toxoplasmosis therapy is recommended in those cases in which CT findings are consistent with toxoplasmosis and the biopsy shows only nonspecific encephalitis. A biopsy of every parenchymal lesion is not considered necessary.