HIV encephalopathy

Case contributed by Dr Coenraad Hattingh

Presentation

Patient presents with confusion.

Patient Data

Age: 50 years
Gender: Male
MRI

The brain, brainstem and cerebellum are strikingly atrophic for this patient’s age. 

There is asymmetrical atrophy of the hippocampi, where the right hippocampus appears sclerotic. 

There is diffuse T2 high signal in the deep and subcortical white matter involving the entire brain. 

Case Discussion

This patient is HIV positive and not on antiretroviral therapy and had a CD4 200 cells/μL.

HIV-1 encephalitis/encephalopathy (HIVE) results from direct HIV infection of the brain. Typically, and in this case, opportunistic infections are absent. Cognitive, behavioural, and motor abnormalities are typically present in 25-70% of cases. This patient presented with confusion. Imaging typically demonstrates atrophy with bilateral diffuse white matter abnormalities.

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Case information

rID: 54203
Case created: 27th Jun 2017
Last edited: 8th Nov 2017
Inclusion in quiz mode: Included

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