CT brain in a pt with multiple ring enhancing les - rftrft609
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CT brain in a pt with multiple ring enhancing les - rftrft609
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02-19-2006, 08:38 PM
lesions .. now if this was the CT & the pt has focal sings & fever & we accordingly treated him /her with sulfadiazin Pyrimethamine & still no response the lesion persisted ..
what is the next best step ? a.brain biopsy b.brain irradiation c.start albendazole d.do brain MRI
02-19-2006, 10:11 PM
A multiple ring enhacing lesion include toxoplasmosisn cns lymphoma .after givin septran if lesion persists then do brain biopsy .i am not sure though
02-19-2006, 10:23 PM
yes I think you r right but what confused me why won't we just go through treatment ..without taking a brain biopsy which is a hard thing to do
02-19-2006, 10:38 PM
I will do MRI to see if the lesions are mostly located in the white matter or subcortical areas etc to narrow ddx of abscess, metastases, lymphoma, glioma, MS etc.. before proceeding biopsy.
02-20-2006, 12:43 AM
rftrft609,
for brain enhancing lesions on CTscan we should focus on the following Toxoplasmosis Lymphoma Brain tumor/metastasis Brain abscess Cysts I think it is wrong to start treating for toxoplasmosis without a thorough work up of the patient. Anyway, from the options you enumerated, you cannot irradiate, what of if it is an abscess? Do we irradiaate abscesses? you should not give albendazole [treatment for round worms] you should not do MRI, CT gives a better result than MRI when it comes to brain imaging. I will take Brain biopsy from the options given, but not without a thorough work up.
02-20-2006, 02:13 AM
It sounds brain biopsy is a better choice to me. Sounds....
02-20-2006, 03:09 AM
we start Tx w/o biopsy (right after the CT) ONLY if we have pt with HIV. In all other cases we do biopsy first and then Tx.
02-20-2006, 03:30 AM
alex i agree with u on this . but still answer must be biopsy
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