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HIV and Its Complications and Needlestick Injuries
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Diagnosis is presumptive, with clinical syndrome, positive toxoplasma immunoglobulin G (IgG) and ring-enhancing lesions on brain imaging. Differentials for a ring-enhancing lesion on CT include toxoplasma, primary CNS lymphoma (PCNSL) or tuberculomata.
Infectious Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Vas Novelli, Delane Shingadia, Huda Al-Ansari
Around 60% of patients remain seizure-free after cysticidal therapy. Patients who have a single ring-enhancing lesion often have spontaneous resolution of the lesion.
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
However, the presence of a ring-enhancing lesion in the brain is not diagnostic of abscess and must be distinguished from a necrotic neoplasm and other cystic lesions. Data from recent studies suggest that DWI is more sensitive than conventional MRI in distinguishing brain abscesses and cystic tumours. Pus in brain abscesses is strongly hyperintense on trace DWI and has a reduced ADC. On the contrary, most necrotic or cystic brain tumours have intermediate signal intensity on DWI and elevated ADC values.
Eslicarbazepine in patients with brain tumor-related epilepsy: a single-center experience
Published in International Journal of Neuroscience, 2021
Marco Zoccarato, Anna Maria Basile, Marta Padovan, Mario Caccese, Vittorina Zagonel, Giuseppe Lombardi
A 54-year-old male presented in June 2018 with a seizure characterized by initial tonic rigidity and left ocular deviation followed by clonic movements mainly located in the left hemiface; urinary incontinence and tongue biting were reported. The patient underwent brain MRI disclosing right fronto-insular hyperintensity on T2 sequences, with thalamic and caudate involvement. After this first episode, sporadic facial movements persisted during hospitalization despite introduction of levetiracetam 3000 mg and lacosamide 300 mg daily. In July 2018, the patient underwent partial resection of the lesion. Histological examination revealed an anaplastic astrocytoma not carrying an IDH mutation. After surgery, a relapse of sub-continuous facial focal motor seizures was only partially controlled by oral phenytoin 300 mg daily. Brain MRI showed a ring-enhancing lesion located anteriorly to the post-operative cavity (Figure 1(c)). The patient underwent radiotherapy plus concomitant temozolomide. During radiotherapy, the patient started to develop clusters of facial clonic contractions occurring several times daily. Given the persistence of the seizures, in December 2018, ESL was added. At 400 mg daily the benefit was poor, but after being increased to 800 mg, a marked reduction in seizures was reported. At the last follow-up, after shifting chemotherapy to fotemustine due to the progression of glioma, only 5 brief episodes weekly were reported with a clear subjective improvement in quality of life.
Varicella-zoster virus causing a ring-like cerebral lesion in AIDS
Published in Baylor University Medical Center Proceedings, 2020
Jennifer Nielsen Fan, Robyn R. Fader, MaryAnn P. Tran, Christie Ann Shen
This case highlights several points. First, it is interesting that varicella-zoster virus vasculitis was the cause of the ring-enhancing lesion. The association of a ring-enhancing lesion with acquired immunodeficiency syndrome, most commonly either a primary central nervous system lymphoma or toxoplasmosis,3 is so prevalent that some believe ring-enhancing lesion is practically pathognomonic for one of these two conditions. However, the differential diagnosis includes other infections (such as Cryptococcus, neurocysticercosis, pyogenic abscesses, tuberculosis, nocardiosis, and toxoplasmosis), neoplastic processes (such as gliomas, glioblastomas, lymphomas, and brain metastases), inflammatory conditions, and vascular etiologies. Even radiation encephalopathy, sarcoidosis, neuropsychiatric systemic lupus erythematosus, Behcet’s disease, and vasculitis are included as possibilities. Therefore, clinicians must maintain a broad differential when working up a ring-enhancing brain lesion.4
The Eye Opener: Finding and Targeting the Midbrain Lesion
Published in Neuro-Ophthalmology, 2018
Aditya Choudhary, Rajveer Singh, Manoj Goyal, Manish Modi
A 14-year-old boy, hailing from a village in Northern India, presented to the neurology outpatient with 10 day history of bilateral ptosis. On interrogation, there was no diurnal variation in the symptoms and he also complained of diplopia on lateral gaze bilaterally. Examination of the eye movements revealed bilateral non-correctable ptosis and bilateral medial rectus palsy (right > left). (Figure 1). Rest of the neurological examination was unrevealing. He was investigated with a contrast enhanced MRI which showed a ring enhancing lesion in the midbrain. When serum ELISA for neurocysticercal antigen was done, it turned out to be positive. He was given a 14 day course of oral steroids with albendazole to which he responded. His ptosis resolved and the ring enhancing lesion cleared from his MR imaging at 1 month of follow up.(Figure 2). Bilateral ptosis results from the central nucleus involvement of the oculomotor nerve which has bilateral innervation. Isolated brainstem involvement in NCC is very infrequent.1,2 Neurocysticercal brainstem involvement usually occurs in disseminated neurocysticercosis.