Neuro case 02

Case courtesy of Dr Vimala

Indication: 30 y/o Chinese male with u/l RVD + on HAART currently being treated as toxoplasmosis
CT brain-multiple bilateral patchy white matter hypodensities with hydrochepalus. TRO Progressive multifocal leukoencephalopathy.

Description
Sequence:
Axial: T2, Flair, Flair post gad, GRE, ADC/ DWI
Saggital: T1

Findings:
Multiple rim enhancing lesion seen at bilateral basal ganglia, thalamus, pons, both parietal, left frontal, right temporal, left occipital and bilateral cerebellum. It returns hyperintense signal rim in T2/ Flair and enhancing post contrast. Some of these lesions demonstrated restricted diffusion in DWI/ ADC and some demonstrated nodular enhancement. Lesion in the right lentiform nucleus demonstrate blooming artefact suggestive of hemorrhagic component. These lesions are associatd with perilesional edema.
No abnormal leptomeningeal enhancemen noted.
No significant midline shift. No hydrocephalus.
Basal cisterns are not effaced

Impression:
In correct clinical context, overall findings are suggestive of toxoplasmosis infection.

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