Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient

Hamdeh, Shadi; Abbas, Anum; Fraker, Jessica; Lambrecht, Jennifer

doi:10.1016/j.ajem.2015.04.071

Cited by 14 publications

(6 citation statements)

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“…The atrophy of the left parietal lobe gray matter was also shown in the preclinical HAND group compared with NCs. A study found that HIV can be isolated from the parietal lobe at autopsy of a patient who had been infected with HIV for 15 days, which suggested that HIV has a greater impact on this area in the early stage of infection ( Hamdeh et al, 2015 ). In our study, only the left parietal lobe gray matter showed atrophy in all cerebral cortices; this may also manifest that the parietal lobe is more vulnerable to HIV attacks than any other parts of the cerebral cortex.…”

Section: Discussionmentioning

confidence: 99%

Brain Volumetric Alterations in Preclinical HIV-Associated Neurocognitive Disorder Using Automatic Brain Quantification and Segmentation Tool

Shi

Wang

et al. 2021

Front. Neurosci.

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PurposeThis study aimed to determine if people living with HIV (PLWH) in preclinical human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND), with no clinical symptoms and without decreased daily functioning, suffer from brain volumetric alterations and its patterns.MethodFifty-nine male PLWH at the HAND preclinical stage were evaluated, including 19 subjects with asymptomatic neurocognitive impairment (ANI), 17 subjects with cognitive abnormality that does not reach ANI (Not reach ANI), and 23 subjects with cognitive integrity. Moreover, 23 healthy volunteers were set as the seronegative normal controls (NCs). These individuals underwent sagittal three-dimensional T1-weighted imaging (3D T1WI). Quantified data and volumetric measures of brain structures were automatically segmented and extracted using AccuBrain®. In addition, the multiple linear regression analysis was performed to analyze the relationship of volumes of brain structures and clinical variables in preclinical HAND, and the correlations of the brain volume parameters with different cognitive function states were assessed by Pearson’s correlation analysis.ResultsThe significant difference was shown in the relative volumes of the ventricular system, bilateral lateral ventricle, thalamus, caudate, and left parietal lobe gray matter between the preclinical HAND and NCs. Furthermore, the relative volumes of the bilateral thalamus in preclinical HAND were negatively correlated with attention/working memory (left: r = −0.271, p = 0.042; right: r = −0.273, p = 0.040). Higher age was associated with increased relative volumes of the bilateral lateral ventricle and ventricular system and reduced relative volumes of the left thalamus and parietal lobe gray matter. The lower CD4+/CD8+ ratio was associated with increased relative volumes of the left lateral ventricle and ventricular system. Longer disease course was associated with increased relative volumes of the bilateral thalamus. No significant difference was found among preclinical HAND subgroups in all indices, and the difference between the individual groups (Not reach ANI and Cognitive integrity groups) and NCs was also insignificant. However, there was a significant difference between ANI and NCs in the relative volumes of the bilateral caudate and lateral ventricle.ConclusionMale PLWH at the HAND preclinical stage suffer from brain volumetric alterations. AccuBrain® provides potential value in evaluating HIV-related neurocognitive dysfunction.

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Section: Discussionmentioning

confidence: 99%

Brain Volumetric Alterations in Preclinical HIV-Associated Neurocognitive Disorder Using Automatic Brain Quantification and Segmentation Tool

Shi

Wang

et al. 2021

Front. Neurosci.

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“…Masses without necrosis tend to be isointense relative to the grey matter. Hemorrhage is common in AR-PCNSL, which is considered to be an inhomogeneous high signal on T1WI [ 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection

Xue

Yan

et al. 2021

BMC Infect Dis

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Background Patients with acquired immune deficiency syndrome (AIDS) often suffer from opportunistic infections and related primary central nervous system lymphoma (AR-PCNSL). Both diseases showed multiple ring enhancement lesions in conventional magnetic resonance (MR). It is very difficult to make the differential diagnosis. We aimed to investigate whether multimodal MR (diffusion weighted imaging (DWI)/ apparent diffusion coefficient (ADC), 3D pseudo-continuous arterial spin labeling (3D-pCASL) and susceptibility-weighted imaging (SWI)) combined with conventional MR can differentiate AR-PCNSL from infections. Methods This was a prospective study. We recruited 19 AIDS patients who were divided into AR-PCNSL group (9 cases) and infection group (10 cases) by pathological results. We analyzed whether there was statistical (Fisher’s method) difference in multimodal MR between the two groups. We analyzed whether multimodal MR combined with conventional MR could improve the diagnosis of AR-PCNSL. Results The lesions were more likely involved the paraventricular (0.020) and corpus callosum (0.033) in AR-PCNSL group in conventional MR. In multimodal MR, AR-PCNSL group showed low ADC value, with p values of 0.001. Infection group more inclined to high ADC value, with p was 0.003. In multimodal MR, AR-PCNSL group had more low signal intensity (grade 2–3) in the degree of intratumoral susceptibility signal intensity in SWI (SWI-ITSS), with p values of 0.001. The sensitivity, specificity of conventional MR in the diagnosis of AR-PCNSL was 88.9 and 70.0%. The conventional MR sequence combined with DWI/ADC sequence in the diagnosis of AR-PCNSL had a sensitivity of 100.0%, and a specificity of 60.0%. The sensitivity and specificity of the conventional MR sequence combined with the SWI-ITSS sequence in the diagnosis of AR-PCNSL were 100 and 70.0%. The conventional MR combined with ADC or SWI-ITSS improved the diagnosis of AR-PCNSL. Conclusion Multimodal MR could distinguish AR-PCNSL from infectious lesions. The multimodal MR (DWI/ADC or SWI-ITSS) combined with conventional MR could improve the diagnosis of AR-PCNSL. The ADC value should be attached importance in clinical work. When distinguishing AR-PCNSL from toxoplasmosis or tuberculoma, SWI should be used to obtain a correct diagnosis.

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“…MR typically presents multiple intracranial annular enhancement foci, which often involve the basal ganglia [2] . In typical cases,T2WI and enhanced scanning show "target signs", but the incidence is less than 30% [13] . T2WI can show hypointensity, which is associatedto coagulative necrosis.…”

Section: Differential Diagnosismentioning

confidence: 98%

A comparative study of multimodal MR in the differential diagnosis of AIDS-related central nervous system lymphoma and infection

Xue

Yan

et al. 2020

Preprint

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Background: To compare the ability of multimodal magnetic resonance(MR) to differentiate acquired immune deficiency syndrome-related(AIDS-related) central nervous system lymphoma (ARL-CNS) from infection.Methods: Clinical data and multiple MR imaging were analyzed retrospectively. Nine cases of ARL-CNS and ten cases with central nervous system infection were included.Results: In conventional MR, there was a statistical significance in whether the lesion involved the paraventricular/corpus callosum. The Fisher values were 0.020 and 0.033 for the lymphoma and infection groups, respectively. In multimodal MR, there were significant differences in the ADC(apparent diffusion coeffecient) values(high/low) and SWI-ITSS grades between two groups, with pvalues of 0.003, 0.001 and 0.001. The sensitivity, specificity and accuracy of conventional MR in the diagnosis of ARL-CNS were 88.9%, 70.0% and 78.9%, respectively. The conventional sequence combined with the DWI/ADC sequence in the diagnosis of ARL-CNS had a sensitivity of 100.0%, a specificity of 60.0% and an accuracy of 78.9%. The sensitivity, specificity and accuracy of the conventional sequence combined with the SWI-ITSS sequence in the diagnosis of ARL-CNS were 100%, 70.0% and 84.2%, respectively.Conclusion: Multimodal MR is of great value in distinguishing ARL-CNS from infection.

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Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient

Cited by 14 publications

References 0 publications

Brain Volumetric Alterations in Preclinical HIV-Associated Neurocognitive Disorder Using Automatic Brain Quantification and Segmentation Tool

Brain Volumetric Alterations in Preclinical HIV-Associated Neurocognitive Disorder Using Automatic Brain Quantification and Segmentation Tool

A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection

A comparative study of multimodal MR in the differential diagnosis of AIDS-related central nervous system lymphoma and infection

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