Central nervous system manifestations of HIV infection in children.

Vertically transmitted HIV infection is a major problem in the developing world due to the poor availability of antiretroviral agents to pregnant women. HIV is a neurotrophic virus and causes devastating neurological insults to the immature brain. The effects of the virus are further compounded by the opportunistic infections and neoplasms that occur as a result of the associated immune suppression. This review focuses on the imaging features of HIV infection and its complications in the central nervous system.

The Kimberley Hospital Rule (KHR) for urgent computed tomography of the brain in a resource-limited environment.

BACKGROUND: The indications for urgent computed tomography of the brain (CTB) in the acute setting are controversial. While guidelines have been proposed for CTB in well-resourced countries, these are not always appropriate for resource-limited environments. Furthermore, no unifying guideline exists for trauma-related and non-trauma-related acute intracranial pathology. Adoption by resource-limited countries of more conservative scanning protocols, with outcomes comparable to well-resourced countries, would have significant benefit. A multidisciplinary team from Kimberley Hospital in the Northern Cape Province of South Africa adopted the principles defined in the National Institute for Health and Care Excellence (NICE) guideline for the early management of head injury and drafted the Kimberley Hospital Rule (KHR), a proposed unifying guideline for the imaging of acute intracranial pathology in a resource-limited environment. OBJECTIVE: To evaluate the sensitivity and specificity of the KHR. METHODS: A prospective cohort study was conducted in the Northern Cape Province between 1 May 2010 and 30 April 2011. All patients older than 16 years presenting to emergency departments with acute intracranial symptoms were triaged according to the KHR into three groups, as follows: group 1 - immediate scan (within 1 hour); group 2 - urgent scan (within 8 hours); and group 3 - no scan required. Patients in groups 1 and 2 were studied. The primary outcome was CTB findings of clinically significant intracranial pathology requiring acute change in management. RESULTS: Seven hundred and three patients were included. The KHR achieved 90.3% sensitivity and 45.5% specificity, while reducing the number of immediate CTBs by 36.0%. CONCLUSION: The KHR is an accurate, unifying clinical guideline that appears to optimise the utilisation of CTB in a resource-limited environment.

Radiological changes post-lymph node enucleation for airway obstruction in children with pulmonary tuberculosis.

BACKGROUND: Tuberculous lymphadenopathy causing airway obstruction in children may be life threatening and may require surgical enucleation of the lymph glands. There are no studies investigating the radiological picture post-enucleation. We attempt to explore this area in our study. METHOD: A retrospective study of the imaging in 21 paediatric cases having undergone tuberculosis (TB) lymph node enucleation. RESULTS: Bronchus intermedius (BI) stenosis was present in 95% of patients undergoing enucleation, followed by left main bronchus (LMB) (81%) and right main bronchus (RMB) (67%) stenosis. Right lung collapse/consolidation occurred more frequently (48-62%) than left-lung collapse/consolidation (10-14%). Resolution of BI stenosis and right lower lobe (RLL) collapse/consolidation is the most consistent postoperative finding. Nine children resolved at an average time of 6.5 months postoperatively, while 10 children were still resolving at an average time of 4.5 months. CONCLUSION: The resolution of the complications of lymph node enlargement (airway stenosis and lung collapse/consolidation) was seen more frequently than the resolution of the offending lymphadenopathy itself. Right-sided disease was necessary to produce complications severe enough to require enucleation. Subcarinal lymph node enucleation is sufficient for resolution of LMB stenosis and associated left-lung sequelae.