Question 2132
{"accessible":false,"alternatives":[{"id":10588,"text":"bacterial brain abscess and syphilitic gumma"},{"id":10592,"text":"cytomegalovirus encephalitis and herpes simplex encephalitis"},{"id":10589,"text":"progressive multifocal leukoencephalopathy and HIV encephalopathy"},{"id":10591,"text":"toxoplasmosis and primary central nervous system lymphoma"},{"id":10590,"text":"tuberculoma and cryptococcoma"}],"archived":false,"correctAlternativeId":10591,"explanation":"\u003cp\u003eIn patients with HIV in developed countries, the most common brain lesions that produce mass effect are toxoplasmosis (toxoplasmic encephalitis, due to\u0026nbsp;\u003cem\u003eToxoplasma gondii\u003c/em\u003e\u0026nbsp;infection) and primary central nervous system lymphoma.\u003c/p\u003e\u003cp\u003eIn countries where tuberculosis is common, tuberculomas should also be considered in the differential of brain mass lesions. Other mass lesions are less common, including cryptococcoma, bacterial brain abscess, and syphilitic gumma. Progressive multifocal leukoencephalopathy and HIV encephalopathy are the leading causes of brain lesions \u003cem\u003ewithout \u003c/em\u003emass effect. Other brain lesions without mass effect are less common, including cytomegalovirus (CMV) encephalitis. Herpes simplex encephalitis is not particularly associated with HIV infection but is a common cause of sporadic viral encephalitis in general.\u003c/p\u003e","id":2132,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2132","nextQuestionPath":null,"relatedArticles":[{"id":1032,"title":"Lymphomas of the central nervous system","link":"/articles/lymphomas-of-the-central-nervous-system?lang=us"},{"id":1410,"title":"Herpes simplex encephalitis","link":"/articles/herpes-simplex-encephalitis?lang=us"},{"id":7274,"title":"HIV-associated dementia","link":"/articles/hiv-associated-dementia-1?lang=us"},{"id":12098,"title":"Progressive multifocal leukoencephalopathy","link":"/articles/progressive-multifocal-leukoencephalopathy?lang=us"},{"id":8614,"title":"Neurotoxoplasmosis","link":"/articles/neurotoxoplasmosis?lang=us"},{"id":54670,"title":"Neurosyphilis","link":"/articles/neurosyphilis?lang=us"},{"id":6677,"title":"Cerebral abscess","link":"/articles/cerebral-abscess-1?lang=us"},{"id":38243,"title":"Intracranial tuberculous granuloma","link":"/articles/intracranial-tuberculous-granuloma?lang=us"},{"id":70937,"title":"Cryptococcoma","link":"/articles/cryptococcoma?lang=us"}],"alsoUsedIn":[{"id":977,"kind":"RestrictedPage","title":"Page 977 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/977"},{"id":976,"kind":"Course","title":"2021 Virtual Conference Private Use - page 976","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/976"},{"id":976,"kind":"Course","title":"2022 Virtual Conference Private Use - page 976","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/976"},{"id":970,"kind":"RestrictedPage","title":"Page 970 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/970"},{"id":955,"kind":"RestrictedPage","title":"Page 955 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/955"},{"id":1,"kind":"LiveSchedule","title":"1","link":"https://radiopaedia.org/admin/live_schedules/1"},{"id":11,"kind":"LiveSchedule","title":"11","link":"https://radiopaedia.org/admin/live_schedules/11"},{"id":932,"kind":"Course","title":"2021 Virtual Conference Private Use - page 932","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/932"},{"id":932,"kind":"Course","title":"Neuroradiology Lectures - page 932","link":"https://radiopaedia.org/courses/neuroradiology-lectures/pages/932"},{"id":932,"kind":"Course","title":"New test course - page 932","link":"https://radiopaedia.org/courses/new-test-course/pages/932"},{"id":1168,"kind":"Course","title":"Adult Neuroradiology Review Course - page 1168","link":"https://radiopaedia.org/courses/adult-neuroradiology-review-course/pages/1168"},{"id":1168,"kind":"Course","title":"Adult Neuroradiology Review Course - page 1168","link":"https://radiopaedia.org/courses/adult-brain-mri-review-course-2015-online-video/pages/1168"},{"id":1177,"kind":"Course","title":"Adult Neuroradiology Review Course - page 1177","link":"https://radiopaedia.org/courses/adult-neuroradiology-review-course/pages/1177"},{"id":1177,"kind":"Course","title":"Adult Neuroradiology Review Course - page 1177","link":"https://radiopaedia.org/courses/adult-brain-mri-review-course-2015-online-video/pages/1177"}],"stem":"\u003cp\u003eA patient with untreated HIV (human immunodeficiency virus) infection in a developed country presents with altered mental status. Neuroimaging reveals multiple brain lesions associated with edema, contrast enhancement, and mass effect. What are the two most likely possibilities in the differential diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2132"}],"attemptsPercentages":[{"alternativeId":"10592","percentage":3},{"alternativeId":"10589","percentage":9},{"alternativeId":"10591","percentage":79},{"alternativeId":"10590","percentage":8},{"alternativeId":"10588","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"cytomegalovirus-encephalitis"}