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Christopher Cimino, MD; Richard B. Lipton, MD; Alan Williams, MD; Elaine Feraru, MD; Carol Harris, MD; Alan Hirschfeld, MD

Arch Intern Med. 1991;151(7):1381-1384.

Abstract
In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome—related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.

(Arch Intern Med. 1991;151:1381-1384)

Author Affiliations
From the Departments of Neurology (Drs Cimino, Lipton, and Feraru), Neurosurgery (Drs Williams and Hirschfeld), and Infectious Disease (Dr Harris), Albert Einstein College of Medicine, Bronx, NY.

Footnotes
Accepted for publication October 31, 1990.

Reprint requests to the Headache Unit, Department of Neurology, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (Dr Lipton).

Presented, in part, at the meeting of The Neurosurgery Society of New York, New York, NY, March 6, 1987, and at the meeting of The American Academy of Neurology, Chicago, Ill, April 17, 1989.

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