Answer for BIR CoW 15 Jun 2025
Neurotoxoplasmosis
Findings
Evidence of multiple T2/FLAIR hyperintense nodular/ rim enhancing lesion in grey white matter junction of bilateral cerebral hemisphere, bilateral basal ganglia, bilateral cerebellar hemisphere and left hemi midbrain showing diffusion restriction with no gradient blooming. Large concentric T2 varying intensity irregular rim enhancing lesion with eccentric nodule involving left basal ganglia with surrounding vasogenic edema causing mass effect in the form of effacement of 3rd ventricle with mid line shift Large concentric T2 varying intensity irregular rim enhancing lesion with eccentric nodules involving left basal ganglia. Multiple small nodular /rim enhancing lesion in grey white matter junction of bilateral cerebral hemisphere, bilateral basal ganglia, bilateral cerebellar hemisphere and left hemi midbrain showing diffusion restriction and mass effect as mentioned above . - Possibly Toxoplasmosis.
Discussion
T1-weighted (pre-contrast): Hypointense lesions T2/FLAIR: Hyperintense lesions with significant surrounding edema Post-Gadolinium T1: Ring-enhancing lesions (classic finding) Typically multiple Predilection for basal ganglia, thalamus, and corticomedullary junction "Target sign" or "eccentric target sign" (central dot or eccentric nodular enhancement within ring) DWI/ADC: Usually no diffusion restriction (helps differentiate from lymphoma) Differential Diagnosis -Primary CNS lymphoma - Tuberculoma - cerebral abscess - Metastasis
References:
1. Chang L, Cornford ME, Chiang FL et-al. Radiologic-pathologic correlation. Cerebral toxoplasmosis and lymphoma in AIDS. AJNR Am J Neuroradiol. 1995;16 (8): 1653-63. AJNR Am J Neuroradiol (citation) - Pubmed citation
2. Ramsey RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin. N. Am. 1997;7 (2): 171-86. Pubmed citation
3. Berry. Diagnostic Radiology : Neuroradiology : Head and Neck Imaging. Jaypee Brothers Medical Publishers (P) Ltd. ISBN:8180616363.
Findings
Evidence of multiple T2/FLAIR hyperintense nodular/ rim enhancing lesion in grey white matter junction of bilateral cerebral hemisphere, bilateral basal ganglia, bilateral cerebellar hemisphere and left hemi midbrain showing diffusion restriction with no gradient blooming. Large concentric T2 varying intensity irregular rim enhancing lesion with eccentric nodule involving left basal ganglia with surrounding vasogenic edema causing mass effect in the form of effacement of 3rd ventricle with mid line shift Large concentric T2 varying intensity irregular rim enhancing lesion with eccentric nodules involving left basal ganglia. Multiple small nodular /rim enhancing lesion in grey white matter junction of bilateral cerebral hemisphere, bilateral basal ganglia, bilateral cerebellar hemisphere and left hemi midbrain showing diffusion restriction and mass effect as mentioned above . - Possibly Toxoplasmosis.
Discussion
T1-weighted (pre-contrast): Hypointense lesions T2/FLAIR: Hyperintense lesions with significant surrounding edema Post-Gadolinium T1: Ring-enhancing lesions (classic finding) Typically multiple Predilection for basal ganglia, thalamus, and corticomedullary junction "Target sign" or "eccentric target sign" (central dot or eccentric nodular enhancement within ring) DWI/ADC: Usually no diffusion restriction (helps differentiate from lymphoma) Differential Diagnosis -Primary CNS lymphoma - Tuberculoma - cerebral abscess - Metastasis
References:
1. Chang L, Cornford ME, Chiang FL et-al. Radiologic-pathologic correlation. Cerebral toxoplasmosis and lymphoma in AIDS. AJNR Am J Neuroradiol. 1995;16 (8): 1653-63. AJNR Am J Neuroradiol (citation) - Pubmed citation
2. Ramsey RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin. N. Am. 1997;7 (2): 171-86. Pubmed citation
3. Berry. Diagnostic Radiology : Neuroradiology : Head and Neck Imaging. Jaypee Brothers Medical Publishers (P) Ltd. ISBN:8180616363.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!