Brain imaging

Brain imaging provides additional support to the diagnosis of HIV-associated dementia, especially by excluding central nervous system opportunistic processes, in particular cerebral toxoplasmosis and primary central nervous system lymphoma.

The predominant finding in HIV-associated dementia is cerebral atrophy; both CT and MRI demonstrate widened cortical sulci and, less commonly, enlarged ventricles. Furthermore, MRI frequently shows high-intensity signal abnormalities on the T 2-weighted image (diffuse widespread involvement, patchy localized involvement, focal distinct areas of involvement, or punctuate white-matter hyperdensities). These lesions are without mass effect and are most commonly located in the periventricular white matter and the centrum semiovale (less frequently, in the basal ganglia or in the thalamus).

As to differential diagnosis, both CT and MRI are able to demonstrate the multiple bilateral ring enhancing lesions that are characteristic of cerebral toxoplasmosis, and the contrast-enhancing mass lesions of primary central nervous system lymphoma.

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