Patient with untreated HIV infection with sudden onset decreased level of consciousness.
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Multiple masses of variable size measuring from 8 to 23 mm with marked surrounding vasogenic edema and central restriction on DWI images are seen in the cerebral hemispheres including, corticomedullary junction, basal ganglia (right caudate nucleus), bilateral thalamus and choroid plexus in the right side. The masses themselves are iso to hyperintense to cortex on T2-weighted imaging, in contrast to the surrounding markedly T2 hyperintense vasogenic edema. The largest one is in the left thalamus. Several have low T2 signal rims. All of the masses show ring enhancement after contrast injection. No intra-lesional calcification.
There is no midline shift or uncal herniation. No tonsillar herniation. No hydrocephalus. Normal paranasal sinuses. Mastoids are normal and the calvarium demonstrates no abnormality.
Serology: Toxoplasma IgG + and CD4 < 100. Anti-toxoplasma therapy was initiated with the resolution of the findings.