MRI findings and use in confused HIV infected patients
INTRODUCTION: HIV/AIDS related neurological disease is important and up to 50% of infected patients present with confusion in their lifetime. CT-based neuroimaging remains key in the management of disease, however access to and use of MRI is increasing. In resource-constrained countries like ours, literature on the use of MRI and the spectrum of MRI-based neurological disease in confused HIV infected patients with focal neurology and a normal prior CT remains scanty. AIM: The aim of the research was to determine the common MRI brain findings in HIV positive adult patients presenting with confusion, who previously had a CT brain scan. METHOD: MRI and CT brain scans of confused HIV infected patients from Helen Joseph Hospital, Johannesburg were retrospectively reviewed. The clinical neurological status was documented and analysed in relation to the CT and MRI findings. RESULTS: Clinical confusion was documented in 26% (87/341) of MRI patients. Focal neurology was present in 87% (67/77) of the 77 included patients. Abnormal MRI findings were detected in 79% (53/67) of the focal neurology cohort. 39% (9/23) of normal CT scans had abnormal subsequent MRI’s -13% (3/23) had HAND and 9% (2/23) had CVA. The presence of focal neurology was a strong predictor of abnormal MRI (p-value: 0,001). CONCLUSIONS: In HIV-infected patients with confusion a significant portion (39%) of MRI scans performed after a prior normal CT was abnormal and underlying HAND or CVA was detected. Furthermore, in the presence of focal neurology and a normal CT scan, an MRI brain is indicated.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Diagnostic Radiology,2019