Primary CNS lymphoma: Difference between revisions
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==Background== | ==Background== | ||
* | *[[AIDS]]-defining malignancy that is strongly related to [[Epstein-Barr virus]] (EBV) infection | ||
*Occurs with profound immunosuppression (CD4 counts <50cells/uL) | *Occurs with profound immunosuppression (CD4 counts <50cells/uL) | ||
* Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs | *Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs | ||
==Clinical Features== | ==Clinical Features== | ||
*Can present with a variety of focal or nonfocal signs and symptoms | *Can present with a variety of [[focal neuro deficits|focal]] or nonfocal signs and symptoms | ||
*Confusion, lethargy, memory loss, hemiparesis, aphasia, mental status changes, seizures | *[[Confusion]], [[lethargy]], memory loss, [[weakness|hemiparesis]], aphasia, [[AMS|mental status changes]], [[seizures]] | ||
*Constitutional symptoms (systemic B symptoms) | *Constitutional symptoms (systemic B symptoms) e.g. [[fever]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{HIV associated conditions}} | |||
==Evaluation== | ==Evaluation== | ||
*CT scan: well-defined focal lesion, isodense or hyperdense to the gray matter | *[[head CT|CT]] scan: well-defined focal lesion, isodense or hyperdense to the gray matter | ||
*MRI | *[[brain MRI|MRI]] (higher diagnostic yield): variable, isointense or hypointense lesions on T1-weighted images | ||
**Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma | **Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma<ref>Forsyth PA. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. 1996;10(5):1125-34.</ref> | ||
*Lumbar puncture: CSF cytology | **Solitary lesions are often large (>4cm)<ref>Thurnher MM. CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol. 1997;7(7):1091-7.</ref> | ||
*[[Lumbar puncture]]: | |||
**CSF cytology | |||
**CSF EBV PCR | **CSF EBV PCR | ||
**Should also obtain toxoplasma serologies, most are treated empirically for toxoplasma while serology is pending | **Should also obtain [[toxoplasma]] serologies, most are treated empirically for toxoplasma while serology is pending | ||
*Stereotactic brain biopsy if | *Stereotactic brain biopsy if necessary | ||
==Management== | ==Management== | ||
*High-dose methotrexate therapy (3 g/m<sup>2</sup> for four to eight cycles) | *High-dose [[methotrexate]] therapy (3 g/m<sup>2</sup> for four to eight cycles) | ||
*[[Steroids]] | |||
*Potent antiretroviral therapy | |||
*Radiation therapy | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[HIV - AIDS (main)]] | |||
*[[HIV neurologic complications]] | |||
==External Links== | ==External Links== | ||
| Line 29: | Line 38: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
[[Category:Neurology]] | |||
Latest revision as of 22:42, 2 October 2019
Background
- AIDS-defining malignancy that is strongly related to Epstein-Barr virus (EBV) infection
- Occurs with profound immunosuppression (CD4 counts <50cells/uL)
- Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs
Clinical Features
- Can present with a variety of focal or nonfocal signs and symptoms
- Confusion, lethargy, memory loss, hemiparesis, aphasia, mental status changes, seizures
- Constitutional symptoms (systemic B symptoms) e.g. fever
Differential Diagnosis
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[1]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- CT scan: well-defined focal lesion, isodense or hyperdense to the gray matter
- MRI (higher diagnostic yield): variable, isointense or hypointense lesions on T1-weighted images
- Lumbar puncture:
- CSF cytology
- CSF EBV PCR
- Should also obtain toxoplasma serologies, most are treated empirically for toxoplasma while serology is pending
- Stereotactic brain biopsy if necessary
Management
- High-dose methotrexate therapy (3 g/m2 for four to eight cycles)
- Steroids
- Potent antiretroviral therapy
- Radiation therapy
Disposition
See Also
External Links
References
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
- ↑ Forsyth PA. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. 1996;10(5):1125-34.
- ↑ Thurnher MM. CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol. 1997;7(7):1091-7.