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

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

TE serology
? TE prophylaxis
Thallium-201 SPECT

Steroids
Open biopsy
Decompression

Steroids
Open biopsy
Decompression

Steroids
Open biopsy
Decompression

Steroids
Open biopsy
Decompression



+

+

+

+

+

Specific treatment

Specific treatment

Specific treatment

Specific treatment

End

End

End

End

Anti-TE trial

Anti-TE trial

Anti-TE trial

Anti-TE trial

Continue treatment

Continue treatment

Continue treatment

Continue treatment

CSF

CSF

CSF

CSF

Specific treatment

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, 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

Impending herniation

+

+

+

+

-

-

-

-

CSF

CSF

CSF

CSF

+

+

+

+

-

-

-

-

Clinical and radiologic improvement after 2 wk

Clinical and radiologic improvement after 2 wk

Clinical and radiologic improvement after 2 wk

Clinical and radiologic improvement after 2 wk

+

+

+

+

-

-

-

-

Biopsy

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

Safe to perform LP

Safe to perform LP

+

+

+

+

-

-

-

-

CT/MRI (Fig. E1)

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) with mass effect

Lesion(s) without mass effect

Lesion(s) without mass effect

Lesion(s) without mass effect

Lesion(s) without mass effect