Management of the Human Immunodeficiency Virus (HIV) Type 1-Infected Patient with Central Nervous System (CNS) Mass Lesions - Flowchart
Management of the Human Immunodeficiency Virus (HIV) Type 1-Infected Patient with Central Nervous System (CNS) Mass Lesions - Flowchart Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome
«Flowchart»

HIV-infected patient with CNS symptoms
CD4+ T lymphocyte counts/HIV viral load

HIV-infected patient with CNS symptoms
CD4+ T lymphocyte counts/HIV viral load

HIV-infected patient with CNS symptoms
CD4+ T lymphocyte counts/HIV viral load


CD4+ T lymphocyte counts/HIV viral load

TE serology
? TE prophylaxis
Thallium-201 SPECT

TE serology
? TE prophylaxis
Thallium-201 SPECT

TE serology
? TE prophylaxis
Thallium-201 SPECT

TE serology
? TE prophylaxis
Thallium-201 SPECT

Steroids
Open biopsy
Decompression

Steroids
Open biopsy
Decompression

Steroids
Open biopsy
Decompression



+

+

+

+

Specific treatment

Specific treatment

Specific treatment

End

End

End

Anti-TE trial

Anti-TE trial

Anti-TE trial

Continue treatment

Continue treatment

Continue treatment

CSF

CSF

CSF

Specific treatment

Specific treatment

Specific treatment

+

+

+

CSF, Cerebrospinal fluid; CT, computed tomography; LP, lumbar puncture; MRI, magnetic resonance imaging; SPECT, single-photon emission computed tomography; TE, Toxoplasma encephalitis.

CSF, Cerebrospinal fluid; CT, computed tomography; LP, lumbar puncture; MRI, magnetic resonance imaging; SPECT, single-photon emission computed tomography; TE, Toxoplasma encephalitis.

CSF, Cerebrospinal fluid; CT, computed tomography; LP, lumbar puncture; MRI, magnetic resonance imaging; SPECT, single-photon emission computed tomography; TE, Toxoplasma encephalitis.

CSF CT LP MRI SPECT TE

Impending herniation

Impending herniation

Impending herniation

+

+

+

–

–

–

CSF

CSF

CSF

+

+

+

–

–

–

Clinical and radiologic improvement after 2 wk

Clinical and radiologic improvement after 2 wk

Clinical and radiologic improvement after 2 wk

+

+

+

–

–

–

Biopsy

Biopsy

Biopsy

+

+

+

–

–

–

Safe to perform LP

Safe to perform LP

Safe to perform LP

+

+

+

–

–

–

Safe to perform LP

Safe to perform LP

Safe to perform LP

+

+

+

–

–

–

CT/MRI (Fig. E1)

CT/MRI (Fig. E1)

CT/MRI (Fig. E1)

Lesion(s) with mass effect

Lesion(s) with mass effect

Lesion(s) with mass effect

Lesion(s) without mass effect

Lesion(s) without mass effect

Lesion(s) without mass effect