45 year old male patient came to casaulty with chief complaints of irrelevant behaviour since last 15 days and headache with projectile vomiting since last 10 days, patient is having HIV status positive since last 5 years and his last CD4 count was 300 done in June 2016, his MRI brain was done, reports are attached with case, how would you proceed further??



As he is hiv positive primary cns lymphoma is higher on cards because granulomatous and other infectious diseases in hiv usually are multiple and present with fever and other constitutional symptoms. As location is in temporal lobe patient presented with irrlevant behaviour and also he had signs of raised ict. Do fundoscopy if he has papilloedema and gcs dropping start him on anti cerebral edema measures and he might require a brain biopsy. After brain biopsy he can be treated accordingly.

First logical step seems to be CSF examination along with AFB stain and India ink stain

Cryptococcal meningitis??

Since there's projectile vomiting, it is a case of shock. veratrum album 200 one dose is recommended. But palliative only if HIV is confirmed.

Give measures to decrease ict first thing Cns lymphoma to be considered Brain biopsy is to be done only if experienced surgeon available

That irrelevant behavior and projectile vomiting are signs of shock. Veratrum album 200 one dose is palliative.

?Cryptococcal meningitis, confirm with CSF analysis...

fungus infection of brain has to be excluded

@Dr. Prakriti Gupta

i think tibulcure meningitis

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