A 48-year-old male patient:
* HIV (+)
* Presented to emergency with headache, confusion, N/V
Axial T2W ImageAxial T2W ImageAxial T2W Image
What do you see?
Axial T2W Image: T2 hyperintense lesions of left caudate nucleus, left putaminal and right dentate nucleus , with perilesional edema (a) Axial FLAIR image(b) Axial FLAIR image(c) Axial FLAIR image(d) Coronal post-contrast T1W imagee) Coronal post-contrast T1W image
Small corticomedullary hyperintense lesions (a-c) with faint enhancement (d-e)
Caudate and putaminal lesions demonstrate faint peripheric contrast enhancement on coronal post-contrast T1W image (a), whereas cerebeller lesion has strong peripheric and central nodular enhancement on coronal post-contrast T1W image (b)Caudate and cerebellar lesions have tiny microhemorrhages on SWI (a-b), a clue for diagnosis
Toxoplasmosis
* Most common opportunistic CNS infection and most common cause of a mass lesion in AIDS
* Basal ganglia, thalamus, corticomedullary junction and cerebellum frequently involved
* Microhemorrhages can be seen on SWI; lesions may have ring or nodular enhancement
* Major ddx is lymphoma
– Lymphoma is usually solitary, whereas solitary lesions are uncommon in toxoplasmosis
– Microhemorrhages are uncommon in lymphoma
Shouldn’t we include fungal and TB infection in the differential list also? Due to hemorrhagic component, nodular and ring enhancing lesion?
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In description right and left side changed.
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