Findings
- Numerous supratentorial and infratentorial enhancing lesions with both parenchymal and leptomeningeal sites of disease. The largest lesion is centered in the right parietal lobe and measures 2.5 x 2.3 cm with peripheral enhancement and restricted diffusion but no central restricted diffusion
- Vasogenic edema associated with many of these lesions with mild local mass effect, particularly in the right parietal lobe, but no midline shift or evidence of herniation or hydrocephalus
- Mucous retention cysts in the right maxillary and left sphenoid sinuses
Diagnosis
Neurotoxoplasmosis
Sample Report
Numerous supratentorial and infratentorial enhancing lesions with both parenchymal and leptomeningeal sites of disease. The largest lesion is centered in the right parietal lobe and measures 2.5 x 2.3 cm with peripheral enhancement but no central restricted diffusion. Mild local mass effect associated with many of these lesions, particularly in the right parietal lobe, without midline shift or evidence of herniation or hydrocephalus. This imaging appearance is most suggestive of an atypical multifocal intracranial infection, with differential considerations in light of patient history including toxoplasmosis, cryptococcosis, and tuberculosis. The multiplicity of lesions and leptomeningeal involvement makes CNS lymphoma a less likely alternate diagnostic consideration. Recommend CSF analysis for further evaluation.
Discussion
References