A male patient on medial tourism (from Syria), presented with left sided weakness.
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Irregular ring enhancing lesions in right gangliothalamic complex, with central necrosis, and marked perilesional edema. MR Spectroscopy revealed raised choline and lipid-lactate peak, with normal NAA:Cr ratio.
On the basis of location, and enhancement pattern, and especially marked perilesional edema, toxoplasmosis was considered. On investigation, patient was found to be HIV +ve. Stereotactic biopsy was planned, however, patient refused.