Brain Targets: Can you Believe Your Own Eyes?

Abstract

SUMMARY - Case ReportsCase AA 48-year-old woman of Peruvian origin presented for subacute onset of weakness in her left limbs. Neurologic examination showed moderate left hemiparesis with ipsilateral Babinski sign and deep tendon hyperreflexia. Head non-contrast enhanced CT scan demonstrated a hypodense lesion in the right diencephalic region. Brain MR scan with gadolinium ( Figure 1A) confirmed the presence of a cystic cavity with mild surrounding oedema and no contrast enhancement. The patient's conditions rapidly worsened; left hemiplegia developed and mental status progressively deteriorated. A second brain MR scan showed a further growth of the lesion. A contrast-enhanced chest and abdomen CT demonstrated multiple cavitary nodular lesions in the right lung with ipsilateral hilar and mediastinal lymphadenopathy. Bronchoscopy was performed; cytological and histological material was retrieved through bronchoalveolar lavage (BAL) and CT-guided lymph node biopsy. Histological examination showed granulomatous inflammation with multinucleated cells and areas of caseous necrosis. Cultural examination on BAL resulted positive for Mycobacterium tuberculosis. Diagnosis: Cerebral tuberculoma. Case BA 32-year-old man of Albanian origin presented with a four-month history of subcontinuous occipital headache, unresponsive to analgesics. Medical history, general and neurologic examinations were unremarkable. Head contrast-enhanced CT scan revealed a hyperdense right parafalcial posterior lesion, with peripheral ring contrast enhancement. Brain MR scan with gadolinium ( Figure 1B) showed two additional small lesions within the right hemisphere, both with ring gadolinium enhancement. Blood tests for HIV, Toxoplasma, Entamoeba and Echinococcus were negative, whereas ELISA assay on plasma resulted