Presentation
Headache, fever and altered consciousness in a patient known for immunosuppressive disease.
Patient Data
Multiple nodular, and ring-enhancing lesions of various sizes with surrounding edema in the posterior fossa and supratentorial region predominantly in the corticomedullary junction, basal ganglia and right thalamus.
The lesion located in the left frontal precentral region shows a series of concentric rings with hyperintense and isointense signals alternatingly on the FLAIR sequence "concentric target sign" with prominent surrounding edema. An adjacent high T1 curvilinear structure is noted suggestive of a cortical vein thrombosis. Slow flow within the transverse sinuses mimicking venous sinus thrombosis.
The lesion located in the left posterior temporal region shows a ring enhancement with enhancing mural nodule "eccentric target sign"
Annotated images:
red arrow indicates the concentric target sign on FLAIR sequence which is a typical sign for cerebral toxoplasmosis
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the green arrow indicates the eccentric target sign on T1 postcontrast sequence which is considered pathognomonic for cerebral toxoplasmosis
Case Discussion
The clinical presentation and MRI features in HIV-positive AIDS patient are most consistent with cerebral toxoplasmosis.
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