Dysarthria, right upper limb weakness, tongue deviation. Normal CT brain.
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Bilateral increased T2 signal is demonstrated along the perforators involving the basal ganglia, and these regions demonstrate prominence high signal on DWI with matching low diffusion values on ADC. DWI demonstrates additional lesions as well as along the left hippocampus. Post-contrast images do not do demonstrate convincing abnormal contrast enhancement. Post-contrast FLAIR, however, demonstrates persistent abnormal T2 signal within the sulci, particularly in the posterior fossa at the base of the brain consistent with meningitis. The course of the hypoglossal nerves and the signal within the tongue musculature is unremarkable.
Conclusion: Features are consistent with CNS cryptococcosis. Diffusion restriction along the right-left hippocampus may be further evidence of infection or maybe due to seizure activity.
This patient went on to have a new diagnosis of HIV with depressed CD4+ count and cryptococcosis confirmed on CSF.
- CD4+ T-cells: 30 x 10^6/L (Normal: 450-1700)
- HIV-1 PCR: detected
- HIV-1 Load: 157,425
- Cryptococcal Ag Serum: positive
- Cryptococcal Ag Serum Titer: 1:160
- Cryptococcal Ag CSF: positive
- Cryptococcal Ag CSF Titer: 1:320
- Cryptococcus neoformans/gattii: Detected