case_images: PMC10946419_01
case_images: Neuroimaging showing the findings of the initial diagnosis of cerebral toxoplasmosis and the first and third subsequent episodes of perilesional edema and enhancement around a calcification secondary to this opportunistic disease. In the first row: initial MRI (10/2010) with the lesion located in the precentral gyrus. (1) T1-weighted image, before contrast administration and (2) post-gadolinium image showing ring enhancement with an eccentric nodule in this lesion; in (3) and (4), T2 and FLAIR images, respectively, showing associated edema in the surrounding white matter. In (5), T2* image (GRE), with no signs of calcification or hemorrhage in this lesion; In the second row: MRI of the first episode of perilesional edema associated with calcification (11/2015). T1-weighted image showing the previous lesion with a smaller size, (6) before and (7) after gadolinium; in (8) and (9), T2 and FLAIR images, respectively, showing associated edema in the surrounding white matter. In (10), T2* image (GRE), some low signal areas can be seen, which may represent early calcium deposits; In the third row: following MRI (03/2016) showing resolution of the first episode of perilesional edema associated with calcification. T1-weighted images, (11) before and (12) after gadolinium, showing significant regression of the lesion enhancement and T2 (13) and FLAIR (14) images without edema. In (15), T2* image (GRE), better definition of the pronounced low signal areas, suggesting intensification of the calcium deposits in the lesion site; In the fourth row: CT and MRI (12/2021) of the last episode of perilesional edema associated with calcification. (16) CT showing calcification in lesion site with surrounding edema and (17) MRI T1-weighted post-gadolinium image with lesion enhancement, as well as increased perilesional edema in T2 (18) and FLAIR (19) images. In (20), T2* image (GRE), increasing of the pronounced low signal areas, compatible with the calcification showed in the concomitant CT scan (16); In the fifth row: subsequent MRI (04/2022) of the third episode of perilesional edema associated with calcification. T1-weighted images, (21) before and (22) after gadolinium, showing resolution of the inflammatory activity with minimal enhancement and the disappearance of the edema in the T2 (23) and FLAIR (24) images. In (25), T2* image (GRE) showing persistence of pronounced low signal areas, compatible with calcification (16).
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case_images: PMC10946419_01_1678-9946-rimtsp-66-S1678-9946202466015-gf01.jpg
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case_images: Her medical history consisted of advanced HIV disease and a well-documented episode of treated cerebral toxoplasmosis presenting right hemiparesis 11 years ago (Figure 1, 1-5). In the first episode, six years ago, the patient was hospitalized for focal seizures and received carbamazepine (Figure 1, 6-10). Four months after discharge, an MRI showed resolution of the perilesional edema associated with calcification (Figure 1, 11-15). Non-contrasted brain computed tomography (CT) scan showed two images compatible with calcifications and a mild perilesional edema was observed around one of them (Figure 1, 16). A corresponding MRI at that time showed these calcifications and the lesion with perilesional edema was increasing after gadolinium administration (Figure 1, 17-20). The calcification site was the same as that of the initial episode of active cerebral toxoplasmosis 11 years before (Figure 1, 1-5). Three months after discharge, the patient was evaluated in our outpatient clinic, continued to be asymptomatic in regular use of medications, and a non-contrast brain CT showed resolution of the calcification-related perilesional edema, a finding confirmed by a corresponding MRI that identified minimal contrast enhancement in the calcified lesion (Figure 1, 21-25).
case_images: Timeline of the case report. cART: combined antiretroviral therapy.
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case_images: PMC10946419_01_1678-9946-rimtsp-66-S1678-9946202466015-gf02.jpg
case_images: f02
case_images: In the first episode, six years ago, the patient was hospitalized for focal seizures and received carbamazepine (Figure 1, 6-10). Four months after discharge, an MRI showed resolution of the perilesional edema associated with calcification (Figure 1, 11-15). A corresponding MRI at that time showed these calcifications and the lesion with perilesional edema was increasing after gadolinium administration (Figure 1, 17-20). Three months after discharge, the patient was evaluated in our outpatient clinic, continued to be asymptomatic in regular use of medications, and a non-contrast brain CT showed resolution of the calcification-related perilesional edema, a finding confirmed by a corresponding MRI that identified minimal contrast enhancement in the calcified lesion (Figure 1, 21-25). The timeline of the clinical evolution of the patient is showed in Figure 2.
case_images: Simplified scheme of the evolution of cerebral toxoplasmosis (A) and parenchymal neurocysticercosis (B) lesions with or without antiparasitic therapy.
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case_images: PMC10946419_01_1678-9946-rimtsp-66-S1678-9946202466015-gf03.jpg
case_images: f03
case_images: In the first episode, six years ago, the patient was hospitalized for focal seizures and received carbamazepine (Figure 1, 6-10). Four months after discharge, an MRI showed resolution of the perilesional edema associated with calcification (Figure 1, 11-15). A corresponding MRI at that time showed these calcifications and the lesion with perilesional edema was increasing after gadolinium administration (Figure 1, 17-20). Three months after discharge, the patient was evaluated in our outpatient clinic, continued to be asymptomatic in regular use of medications, and a non-contrast brain CT showed resolution of the calcification-related perilesional edema, a finding confirmed by a corresponding MRI that identified minimal contrast enhancement in the calcified lesion (Figure 1, 21-25).