Presentation
Patient with a past medical history of HIV/AIDS presents with 1 week of headache and syncope.
Patient Data
MRI of the brain demonstrates multifocal lesions throughout the corticomedullary junctions and cerebellum. Lesions display alternating bands of hyper and hypointensity on T2WI and extensive surrounding vasogenic edema. Post-contrast imaging displays spiraling ring enhancement with an eccentric target sign (seen best within the left temporal lobe lesion on axial T1 C+). DWI displays intermediate diffusivity peripherally though without central diffusion restriction.
Case Discussion
This case displays the typical appearance of the CNS manifestations of toxoplasmosis in an immunocompromised patient. The alternating bands of hyper and hypointensity on T2WI and eccentric target sign are particularly suggestive despite sparing of the basal ganglia. This case was confirmed following surgical resection.
Co-Author: Daniel P. Gewolb, M.D.
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