Summarycolon;Over the past decade, AIDS has become the leading public health crisis in the United States, Western Europe, and Africa. Despite recent advances in molecular biology and immunology and improvements in diagnosis and treatment, the AIDS epidemic continues to grow, absorbing a greater proportion of limited financial, medical, and human resources. As neuropathologic disease occurs in nearly half of all symptomatic patients, clinicians must recognize the wide spectrum of neurological manifestations of AIDS and utilize the most efficacious diagnostic and treatment programs. The workhyphen;up of the AIDS patient with neurological symptoms consists of careful physical examination, radiographic imaging, and laboratory studies. MR imaging with gadolinium is currently the radiographic screening study of choice. While the diagnosis cannot be established on the basis of radiographic findings alone, patients with a solitary lesion on MR images are more likely to have lymphoma than any other diagnosis and should undergo early stereotactic biopsy before the initiation of radiation therapy. Any patient with a mass lesion that does not respond to empirical therapy for toxoplasmosis should also undergo stereotactic biopsy to exclude another treatable disease. The number of stereotactic procedures performed is likely to increase over the next several years. The increasing threat of HIVhyphen;1 infection requires meticulous care both in and out of the operating room in order to minimize accidental exposure.
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