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Brain biopsy in AIDS. Diagnostic value and consequence
C J Nielsen1, F Gjerris, H Pedersen
1University Clinic of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
Abstract:
Nineteen male patients with AIDS were investigated by biopsy of brain lesions. Six patients had progressive multiple leucoencephalopathy and no specific treatment was given. Toxoplasmosis (two patients), bacterial abscesses (two cases), viral encephalitis (two patients) and only gliosis (two cases) accounted for almost half of the cases. A fungal infection, a lymphoma and a sarcoma-like tumour were found in three patients. In two patients the biopsy was not diagnostic: one had only necrosis and one had normal findings. The biopsy findings gave reason for modifying the treatment in only three cases. The mean survival rate was relatively short, only 76 days with a range from 1 to 1041 days. Two patients were in a very bad clinical condition at the time of biopsy and one died of a haemorrhagic complication due to the biopsy. In ten cases an autopsy was carried out. In five cases there was agreement between the biopsy and autopsy findings. In the other five cases the autopsy findings differed widely. In our experience we can recommend cerebral biopsy in patients with AIDS only after treatment for toxoplasmosis and mainly to estimate the prognosis.
Insights
Brain biopsies in patients with acquired immunodeficiency syndrome (AIDS) revealed diverse lesions, often differing from autopsy findings. Cerebral biopsy is recommended post-toxoplasmosis treatment for prognosis estimation in AIDS patients.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Acquired immunodeficiency syndrome (AIDS) can manifest with various neurological complications.
- Brain biopsies are crucial for diagnosing neurological lesions in immunocompromised patients.
Purpose of the Study:
- To investigate the diagnostic yield and clinical impact of cerebral biopsies in patients with AIDS.
- To compare biopsy findings with autopsy results and assess their correlation.
Main Methods:
- Retrospective analysis of 19 male AIDS patients undergoing brain biopsy.
- Histopathological examination of biopsy specimens.
- Correlation of biopsy findings with clinical data and autopsy results where available.
Main Results:
- Progressive multifocal leukoencephalopathy (PML) was diagnosed in 6 patients.
- Other diagnoses included toxoplasmosis, bacterial abscesses, viral encephalitis, gliosis, fungal infections, lymphoma, and sarcoma-like tumors.
- Biopsy findings led to treatment modification in only 3 cases.
- Mean survival was short (76 days).
- Discrepancies were noted between biopsy and autopsy findings in 50% of cases.
Conclusions:
- Cerebral biopsy in AIDS patients has a limited role in guiding treatment but can aid prognosis.
- Biopsy is most recommended after toxoplasmosis treatment.
- Discrepancies between biopsy and autopsy highlight diagnostic challenges.