HIV patient in confused state

A 35 year old male was brought by the neighbor in a confused state. History He has altered mental status for around 1 month along with the blurry vision for 3 days (explained by family members). He is disoriented, has disorganized behavior & sometimes hallucinations also. He stumbles over words and stops recognising people, even family members. He has h/o HIV infection. Vitals Blood pressure of 120/75 mmHg, Heart rate of 83 beats/min, Respiratory rate of 19 breaths/min, Temperature: 98.4°F, O2 saturation of 100% on room air. Investigations Blood investigations normal. No weakness or abnormal sensation. MRI is posted below. Diagnosis Please comment on the MRI.




Sir - these are,not MRI images . These are NCCT- images . In fact - Patient requires MRI scan - and post MRI images . There is infarct- involving the left occipital area,extending upwards and midline .

Necessary investigating methodology has not been followed. You have posted NCCT images, where as the situation require Post MRI images. Though it seems to have developed Infarct. Well...,you wrote ,he had history of HIV but did not post about the history/ duration of treatment and present status and maretial status

Dr ,you have posted the NCCT brain. Kindly post the MRI MRI brain with contrast with MR soectroscopy. NCCT shows white matter edema left parietal.Needs MRI brain with contrast and MR spectroscopy

Post MRI scan reports. Probable diagnosis. * Infraction ** compression due oedema or pathology. Needs expert opinion and relevant investigation and evaluation.


MRI film shows posterior reverse encephalopathy syndrome See for blood report with esr See for ecg See for Chest xray And treat accordingly

See for ammonia level

Along with MRI, plz do CD4 count, serum TOXO IgG and CMV DNA and csf study of same pathogen and csf vdrl . Since eye also involved , toxo and cmv has the potentiality to affect both cns and eye if cd4 is low and central optic field lesion also to be excluded. Neuro Syphilis also has potentiality to produce meningovascular damage which look alike a cva. So exclude opportunistic infection 1st ,it will help you.

Focal oedema. Needs CECT with retro images

Ischemic Stroke

Pres maybe due to Immunosuppresy drugs

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