Question

What can I do after an MRI scan has found lesions in my brain?

29 November 2006. Related: All topics, Opportunistic infections, Other tests.

Six months ago I woke up with a numbness across my upper lip and side of my face corresponding with my right hand (same symptoms) and left leg going into the foot affecting my balance. I had an MRI scan indicating 2 lesions on the right side of my brain, in grey matter plus 3 on my left side.

The doctors thought it might be PML but I had a lumber punch and the JC virus was not found in the spinal fluid. My doctor changed my ARV’s to Combivir 300/150 and Virammune 200mg. Both tables twice a day. Presently there has been no there deterioration and no improvement.

Is there anything any treatment available for these symptoms? or does one have to learn to live with it.

Answer

Answer: Simon Collins

Brain lesions identified by MRI can be related to a wide range of complications. This includes toxoplasmosis, central nervous system lymphoma, PML, HIV encephalopathy, TB, VZV (varicella virus – the virus that causes chicken pox and shingles), CMV, syphilis and others.

The lesions look different for different diseases. Although definite diagnosis can sometimes be difficult, an expert can usually distinguish the differences.

It is important that you see an expert as treatments are different depending on the cause,

Using drugs in your ARV combination that definitely penetrate the brain may also help. So perhaps changing 3TC to abacavir could strengthen this aspect of your regimen, or using a ritonavir-boosted protease inhibitor. See CNS penetration of ARV drugs is associated with lower CSF viral load.

There are various online overviews that may also help with information, including:

• Neurologic Aspects of HIV/AIDS
• Recent Advances in Managing Neurologic Adverse Effects of Antiretroviral Therapy
• Focal Brain Lesions in HIV-Infected Patients (requires one-time free registration)